HomeMy WebLinkAbout04-1155PETITION FOR PROBATE and GRANT OF LETTERS
also known as To'.'
, Deceased.
Social Security No. t/ ~ a~ - / 2 ~ ~ 72- ~l
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an t}ae executz~e--
in the last will of the above decedent, dated /f/~'P'c°~,~ ~' ff 2./
and codicil(s) dated
Register of Wills for the
County of ~ltn4/~,r-/~q ot in the
Commonwealth of Pennsylvania
named
Decendent was domiciled at death in /5f/~',,'~ ~'r-/~:~, ~/ County. Pennsylvania, with
h~ last family ~r~rincjpal residence at ~ ~<~
(list street, numar ~d muncipality)
Decendent, then ~ ye~s of age, died /~~ /P~ ~ ~
Except as follows, decedent did not mar~, w~ not ~vorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing ~d was never adjudicated
incompetent:
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property $ /~:5'"~',
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania. ~, ~.-. $. /~'~'~ ~'~
situated as follows' ,~bt ~0, /2Z4r/t/,5'/~
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters
theron. (testamentary; admimstration c.t.a.; administration d.b.n.c,t.a.)
o OATH OF'PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA '~
COUNTY OF (-2-o~,-,kn~,_\c~,,~r~ 3' ~s
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) w_ll well and truly administer the estate according to law.
Sworn to or affirme~d~d subscribed
bef-qre me this I'-I ' day of
No. &t-
~EC~EE OF ~RO~ATE AND GRANT @F LETTERS
, Deceased
AND NOW ~'~/
the reverse side hereof, satisfacrou proof having been presented before me,
IT iS DECREED that the instrument(s) dated \
described therein be admitted to probate and filed of record as the last will of
and Letters .,~zo..4-,-,~*-~¢~,,-,~,
are hereby granted
/'-'[. oq-(''~'~L/ ~-9 . in cons~deraaon of the peduon on
FEES
Probate, Letters, Etc .......... $
Short Certificates( ) .......... $
$
TOTAL 1.
Filed . [ ~ :. [~: &~ ..................
Register of Wills ~r~A--~.
ATTORNEY (Sup. Ct, LD, NO.)
ADDRESS
PHONE
Register of Wills Of CumberlandCounty, Pennsylvania
OATH OF SUBSCRIBING WITNESS
Estate of S. Louise Shelley
also known as
, Deceased
Joel O. Sechrist and Linda J. McDaniel
(each) a subscribing witness to the ~.iJ codicil(s) [Xwill(s) presented herewith, (each) being duly qualified according
to law depose(s) and say(s) that she/he/they was/were present and saw the above Testator(rix) sign the same and
that ~/h~they signed as a witness at the request of Testator(rix) in his~er/t4~e~r presence and iX in the presence
of each other [] in the presence of the other subscribing witness(es).
5~68 (Signature)
Old York Road, Etters PA 17319
)Address)/. ,
1250 Stillhouse Lane, Etters
PA
17319
(Address)
Sworn to or affirmed and subscribed
before me this / 7"~'~' day of
My Commission Expires: 7 - $l -<:)~'
Notarial Seal
Patricia A. Gordon, Notary Public
Fairview Twp,, York County
My Commission Expires July 31,200.5
Member, Pennsylvania As~oclatieo of Nola~
NOTE:
Please have present the original or copy of Instrument(s)
his is to certify that the information here given is correctl5 copied fi'om an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy' by photostat or photograph.
Fee for this certificate, $2.00
P 10897498
No.
iLocal Registrar
-.~
DEC 1 4 2004
COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
Date
C'~
Sara Louise Shelley 2 Female a 183 -- 12 -- 2724 ~ December 10, 2004
1-5-1915 PA ~.,.,d--J ~v~,~.., [-] oo^ [-I ~ Hospice
COUNIyO[OEATH CiTy. ttORO, T~OFDEATH I"'. I "0~' [] """'""[] ,,.~.;~, []
Montour Danville Maria Hall M'XI~'P~RI~ ~ White
Teller Bankin
o~c[~e~rs Ha. [ z [~, Widow I~*
Mechanicsburg, PA 17055 (S~ insl~ns live in a
~, H~chael Na~io~ J~. 65~ 5Ch SCreen, ~o~humbe~la~d, ~A ~7857
I~,~.December lS, 2004,,..PennsTlvanta Cremator~ [~,~ .arrXsburo p~ t7109
~=~YD138202 [~Se~ces, Inc., Harrisburg. PA 17109
~F-RE AUTOPSY FINDINGSIMANNER OF D~ATH
PERFORMED? ~'VAILABL~: PRIOR TO m
DATE OF INJURY T M~ OF INJURY INJURY AT V'ORK?I DESCRIBE HOW }N JURY OCCURRED
I
LAST WILL AND TESTAMENT OF
s. LOUISE SHELLEY
I, S. LOUISE SHELLEY, of the Borough of Mechanicsburg, Cumberland County,
Pennsylvania, being of sound mind and memory, do make, publish and declare this my Last Will and
Testament, hereby revoking and making void any and all wills by me heretofore made.
FIRST: I order and direct that all of my just debts and funeral expenses be paid by my
hereinafter named Executor as soon after my death as may be found convenient.
SECOND: I give the sum o£FIVE THOUSAND ($5,000.00) DOLLARS to WILLARD
WATERMAN MEMORIAL COURT NO. 54, ORDER OF AMARANTH, absolutely.
THIRD: I give the sum of TEN THOUSAND ($10000.1)0) DOLLARS to
STEADFAST CHAPTER OF EASTERN STAR, absolutely.
FOURTH: I give the sum of FIVE THOUSAND ($5,000.00) DOLLARS to
MECHANICSBURG FIRE DEPARTMENT, absolutely.
FIFTH: I give the sum of FIVE THOUSAND ($5,000.00) DOLLARS to
MECHANICSBURG AREA MEALS-ON-WHEELS, absolutely.
SIXTH: I give the sum of TEN THOUSAND ($10,000.00) DOLLARS to
I~ CHANICSBURG AREA SCHOOL DISTRICT, absolutely, for use and promotion of speech and
c~ate
r--- ~NTH. I g~ve the sum of FIVE THOUSAND
II~CH~S~ BURG AREA PUBLIC LIBRARY, absolutely
g~l EIG¥~TH:
($5,000.00) DOLLARS to
I give the sum of TWENTY THOUSAND ($20,000.00) DOLLARS to FIRST
1 S. Louise Shelley - ~
UNITED METHODIST CHURCH of Mechanicsburg, Pennsylvania, absolutely.
NINT}I: I give, devise, and bequeath all the rest, residue and remainder of my estate,
real, personal and mixed, of whatever nature and wheresoever situate, which I may own or have the
right to dispose of at the time of my death unto my son, W. MICHAEL NAILOR, absolutely, if he
survives me. In the event that my son fails to survive me then I give, devise, and bequeath all the
rest, residue and remainder of my estate, real, personal and mixed, of whatever nature and
wheresoever situate, which I may own or have the right to dispose of at the time of my death unto
FIRST UNITED METHODIST CHURCH of Mechanicsburg, Pennsylvania, absolutely.
TENT}I: I hereby nominate, constitute and appoint my son, W. MICHAEL NAILOR, as
Executor of this, my Last Will and Testament, and I do direct that no bond shall be required of such
Executor hereunder. My said Executor shall have full power at his discretion to. do any and all things
necessary for the complete administration of my estate, including the power to sell at public or
private sale and without order of Court, any real or personal property belonging to my estate, and to
compound, compromise or otherwise to settle or adjust any and all claims, charges, debts and
demands, whatsoever, against or in favor of my estate, as fully as I could do if living.
In the event that my son, W. MICHAEL NAILOR, does not survive me or fails to qualify,
then I nominate, constitute and appoint WACHOVIA BANK, as the alternate Executor. Said
alternate Executor shall have all of the powers, privileges, duties and immunities as hereinbefore
more fully set forth for my original Executor.
IN WITNESS WHEREOF, I, S. LOUISE SHELLEY, the above Testatrix have set my hand
and seal to this my Last Will and Testament, which consists of three (3) page~, to each of which I
2 ~. Louise Shelley
have affixed my signature this ~ / 4~-~ day of
S. E~u~e Shelley
,2001.
(SEAL)
Signed, sealed, published and declared by the above named Testatrix 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 subscribed our names as witnesses.
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717)240-6345
Date: 02/28/2005
NAILOR W MICHAEL
651 FIFTH STREET
NORTHUMBERLAND, PA 17857
RE: Estate of SHELLEY SARA LOUISE
File Number: 2004-01155
Dear Sir/Madam:
It has come to my attention that you have not filed the
Certification of Notice Under Rule 5.6 (a) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES,
NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on
or after July 1, 1992, the personal representative or his
counsel, within ten (10) days after giving proper notice to the
beneficiaries and intestate heirs as required by subdivision
(a) of Rule 5.7, shall file with the Register of Wills or Clerk
of the Orphans' Court his/her Certification of Notice.
This filing is due by:
03/27/2005
Your prompt attention to this matter will be appreciated.
Thank You.
~~~
GLENDA FARNER STRASBAUGH
Clerk of the Orphans' Court
cc: File
Counsel
Judge
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(1 1-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NAILOR W MICHAEL
651 FIFTH STREET
NORTHUMBERLAND, PA 17857
___nOn fold
ESTATE INFORMATION: SSN: 183-12-2724
FILE NUMBER: 2104-1155
DECEDENT NAME: SHELLEY SARA LOUISE
DATE OF PAYMENT: 03/07/2005
POSTMARK DATE: 03/07/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 12/10/2004
NO. CD 005026
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $88,000.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 996
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
$88,000.00
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
-.
Register of Wills of Cumberland County
CERTIFICATION OF NOTICE UNDER RULE S.6fA)
d Sara Louise Shelley
Name of Dece ent:
Date of Death: December 10, 2004
E tat N . 2004-01155
s eo..
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the
Orphans' Court Rules was served on or mailed to the foHowing beneficiaries of the above-captioned estate on
February 21, 2004
Name
Address
Mechanicsburg Area Meals-On~Wheels
PO Box 1093, Mechanicsbur9, PA 17055
Mechanicsburg Area School District
500 South Broad Street, Mechanlcsbur9, PA 17055
MechanicSburg Fire Depart,efnent
c/o 316 South York Street, Mechanicsburg, PA 17055
Willard-Waterman Court No. 54, Order of AI c/o 3518 Nottingham Way, Harrisburg PA 17019
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date: 3/'1/~t15-
-/d'l>>~ ~.rU/~
Signature
W. Michael Nailor
:.'J
Name
651 Fifth Street
Northumberland, PA 17857
Address
570-473-3608
Telephone
Capacity:
IBI Personal Representative
o Counsel for personal representative
>
-.
Register of Wills of Cumberland County
CERTIFICATION OF NOTICE UNDER RULE 5.6lAl
d Sara lou;se Shelley
Name of Dece ent:
D t fD th December 10, 2004
a e 0 ea:
E tat N ' 2004-01155
s eo..
To the Register:
] certifY that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the
Orphans' Court Rules was served on or mailed to the following beneficiaries ofthe above-captioned estate on
February 21, 2004
Name
Address
Steadfast Chapter No, 479, Order of Easter c/o 2421 Clover Drive, Mechanicsburg, PA 17055
First Unlled Methodist Church
135 West Simpson Street, Mechanicsburg, PA 17055
Notice bas now been given to all persons entitled thereto under Rule 5.6(0) except
Date: o/i /cPt1tf S-
~~ff~
Signature
W. Michael Nailor
Name
651 Fifth Street
Northumberland, PA 17857
>')
Address
570-473-3608
Telephone
Capacity:
~ Personal Representative
o Counsel for personal representative
~~V-1!i!lO EX /jOO) REV-1500 OFFICIAL USE ONLY
COMMONWEALTH OF
PENNSYLVANIA INHERITANCE TAX RETURN
DEPARTMENT OF REVENUE FILE NUMBER
DEPT. 280601 RESIDENT DECEDENT 2L -tL~ 1-L55-_
HARRISBURG, PA 17128-0601 COUNfY CODE YEAR fliJMBER
DECEDENT'S NAME (lAST, FIRST, AND MIDDLE INrnAL) SOCIAL SECURIIY NUMBER
I-
Z SHELLEY, S. LOUISE 183-12-2724
W DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD- YEAR) THIS RETURN MUST BE A LED IN DlJPUCATE WITH THE
C
W 12-10-2004 1/5/1915 REGISTER OF WILLS
0
W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURIIY NUMBER
C
w [Xl 1. Original Return 0 2. Supplemental Return 0 3. Remainder Return (date of ~th prior to 12-13-82)
I-
~~Ul 0 4. Limited Estate 0 4a. Future Interest Compromise (date of deeth after 12-12-82) [Xl 5. Federal Estate Tax Return ~equired
ul!:~
wo..u 6. Decedent Died Testate (Attach copy o{WiII)
IOO [Xl 0 7. Decedent Maintained a Living Trust (Mach copy of Trustl l8. Total Number of Safe DepP~it Boxes
ul!:-'
o..al
0.. 0 9. Litigation Proceeds Received o 10. Spousal Poverty Credit (date of deeth between 12-31-91 ard 1-1-95) o 11. ElectiontotaxunderSec.9~13(A) (AnechSchOI
<(
t- THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONRDENTIAL TAX INFORMATION SHOULD BE IPlRECTED TO:
z NAME COMPLETE MAILING ADDRESS
w
0 w. MICHAEL NAILOR 651
z FIFTH STREET
0
0.. FIRM NAME (If A~licable) NORTHUMBERLAND, PA 17857
Ul
w
a:
a: TELEPHONE NUMBER
0
u 570-473-3608
1. Real Estate (Schedule A) (1) 157,000 , 9~FICIAL ~ . ~E O~.,LYr:~~
1,001,612 r , j ,
2. Stocks and Bonds (Schedule B) (2) , (.)
.:.. )
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 0 - :-.;
. " ' I -,.-j
I " ~I
4. Mortgages & Notes Receivable (Schedule D) (4) 0
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 325,875
Z (Schedule E) :
0 6. Jointly Owned Property (Schedule F) (6) 48,579 ~
~ o Separate Billing Requested Q
..J 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 712,905
:;:)
I- (Schedule G or L)
D: 8. Total Gross Assets (total Lines 1 - 7) (8) 2,245,971
<I:
0 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 63,520
w
a: 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 0
11. Total Deductions (total Lines 9 & 10) (11) 63,520
12. Net Value of Estate (Line 8 minus Line 11) (12) 2,182,451
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13) 60,000
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) ;2,122,451
SEE INSTRUCTIONS FOR APPUCABLE RATES
Z
0 15. Amount of Une 14 taxable at the spousal tax
~ rate, or transfers under See. 9116 (a)( 1.2) X.O_ (15) 0
2 , 122 , 4 51 X .0 45 !
~ 16. Amount of Line 14 taxable at lineal rate (16) , 95,510
:;:) !
Q. 17. Amount of Line 14 taxable at sibling rate X .12 (17) 0
:E I
0 18. Amount of Line 14 taxable at collateral rate X .15 (18) 0
0
~ I
19. TaxDue (19) 95,510
20. 0 I CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT I
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
STFPA42021F.1
II
.DeceMent's Complete Address:
STREET ADDRESS 3 0 4 WEST MAIN STREET
CI1Y MECHANICSBURG I STATE PA I ZIP 1 7 0 5 5
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
95,510
88,000
4,632
Total Credits (A + 8 + C) (2)
92,632
3. I nterest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E) (3)
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 (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
o
o
2,878
A. Enter the interest on the tax due.
(5A)
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
2,878
II
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BlOOKS
No
~
~
~
~
~
[Xl
contains a beneficiary designation? ..................................................... .. IXI 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND RLE IT AS PART Of 'THE RETURN.
I
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, corrept and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE PERSON ESPON 18 OR Fill RETURN
1. Did decedent make a transfer and: Yes
a retain the use or income of the property transferred; ........................................ 0
b. retain the right to designate who shall use the property transferred or its income; . . . . . . . . . . . . . . . . . .. 0
c. retain a reversionary interest; or ....................................................... 0
d. receive the promise for life of either payments, benefits or care? ............................... 0
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0
3. Did decedent own an '~n 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
t11~
ADDRESS
651 FIFTH STREET, NORTHUMBERLAND PA 17857
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
ADDRESS
i I
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 survivi~g spouse is 3%
[72 P.S. S9116 (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 't---..
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of 1 u0 e.
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 te
parent, or a stepparent of the child is 0% [72 P.S. S9116(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
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. S9116(a)(1
individual who has at least one parent in common with the decedent, whether by blood or adoption.
8loSoD
'YC\ Lll\ 5 .00
\~ P D '-12C> cD
~ .~~~T
1.1) (ii)].
Ie even
Ie
6(a)(1)].
~, as an
STFPA42021F.2
I!
.' REV-lrF EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
S. LOUISE SHELLEY 2104-1155
All real property owned solely or as a tenant in oommon 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. Reel property which is jointly-owned with right of survivorship
must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
HOUSE - 307 WEST MAIN STREET, MECHANICSBURG
VALUE PER ATTACHED APPRAISAL FROM FORRESTER
REAL ESTATE APPRIASERS
PA 1705t
& CO.
VAWE AT DATE
OF DEATH
157,000
SlF PA42021 F.3
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
157,000
II
." REV-1Ef EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
S. LOUISE SHELLEY
RLE NUMBER
2104-1155
All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
6
WACHOVIA SECURITIES CAP ACCOUNT 9620393431
STATEMENT ATTACHED
VARIOUS - JANNEY MONTGOMERY ACCOUNT WH92 7571-5835
STATEMENT ATTACHED
ACCRUED INTEREST ON ITEM NUMBER 2
PPL 2400 COMMON SHARES
VARIOUS MUNICIPAL BONDS - WACHOVIA ACCOUNT NUMBER
000001519897950 - STATEMENT ATTACHED
ACCRUED INTEREST ON ITEM NUMBER 5
VALUE AT DATE
OF DEATH
116,993
1.
2
83,862
3
4
5
227
125,088
672,756
2,686
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1,001,612
STF PA42021F.4
II
. REV-Hit' EX + (1-97) (I)
,
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C
ClOSEl V-HELD CORPORATION,
PARTNERSHIP or SOLE-PROPRIETORSHIP
ESTATE OF
S. LOUISE SHELLEY
ALE NUMBER
2104-1155
Schedule C-l or C-2 (Including all supporting information) must be attached for each closely-held corporatiorVpartnership interest of the decedent, other than a sole-proprietorship.
See instructions for the supporting information to be submitted for sole-proprietorships.
ITEM
NUMBER
DESCRIPTION
VA~UE AT DATE
OF DEATH
1.
STFPA42021F.5
TOTAL (Also enter on line 3, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
o
" REV-15l5 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE c-1
CLOSELY-HELD CORPORATE
STOCK INFORMATION REPORT
ESTATE OF
S. LOUISE SHELLEY
ALE NUMBER
2104-1155
Address Date of Incorporation
City State Zip Code Total Number of Shareholders
2. Federal Employer I.D. Number Business Reporting Year
3. Type of Business Product/Service
4. TYPE TOTAL NUMBER OF NUMBER OF SHARES VALUE OF THE
STOCK Voting I Non- Voting SHARES OUTSTANDING PAR VALUE OWNED BY THE DECEDENT DECED~NTS STOCK
$ :
Common
Preferred $ ,
Provide all rights and restrictions pertaining to each class of stock.
5. Was the decedent employed by the Corporation? DYes DNo
If yes, Position Annual Salary $ Time Devoted to Business
6. Was the Corporation indebted to the decedent? DYes DNo
If yes, provide amount of indebtedness $
7. Was there life insurance payable to the corporation upon the death of the decedent? DYes DNo
If yes, Cash Surrender Value $ Net proceeds payable $
Owner of the policy
8. Did the decedent sell or transfer stock of this company within one year prior to death or within two years if the date of death was prior to 12-31482?
DYes DNo If yes, D Transfer D Sale Number of Shares
Transferee or Purchaser Consideration $ Date
Attach a separate sheet for additional transfers and/or sales.
9. Was there a written shareholder's agreement in effect at the time of the decedent's death? DYes DNo
If yes, provide a copy of the agreement.
10. Was the decedent's stock sold? DYes DNo
If yes, provide a copy of the agreement of sale, etc.
11. Was the corporation dissolved or liquidated after the decedent's death? DYes DNo
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
12. Did the corporation have an interest in other corporations or partnerships? DYes DNo
If yes, report the necessary infonnation on a separate sheet, including a Schedule C-1 or C-2 for each interest.
THE FOLLOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE i I
A. Detailed calculations used in the valuation of the decedent's stock. I
I
B. Complete copies of financial statements or Federal Corporate Income Tax returns (Fonn 1120) for the year of death and 4 preceding year~.
C. If the corporation owned real estate, submit a list showing the complete addressles and estimated fair market value/s. If real estate apprai~als have been
secured, attach copies.
D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent.
E. List of officers, their salaries, bonuses and any other benefits received from the corporation.
F. Statement of dividends paid each year. List those declared and unpaid. ,
G. Any other infonnation relating to the valuation of the decedent's stock.
STF PA42021 F.6
Name of Corporation
State of Incorporation
" REV-l5/f EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE c-2
PARTNERSHIP
INFORMATION REPORT
ESTATE OF
S. LOUISE SHELLEY
FILE NUMBER
2104-1155
1. Name of Partnership
Address
Date Business Commenced
Business Reporting Year
City State Zip Code
2. Federal Employer I.D. Number
3. Type of Business Product/Service ,
4. Decedent was a o General o Limited partner. If decedent was a limited partner, provide initial investment $
5. PERCENT OF PERCENT OF BALANCE OF
PARTNER NAME INCOME OWNERSHIP CAPITAL ACCOUNt
A.
B.
C.
D.
6. Value of the decedent's interest $
7. Was the Partnership indebted to the decedent? DYes DNo
If yes, provide amount of indebtedness $
8. Was there life insurance payable to the partnership upon the death of the decedent? DYes DNo
If yes, Cash Surrender Value $ Net proceeds payable $
Owner of the policy
9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior td 12-31-82?
DYes DNo If yes, o Transfer o Sale Percentage transferred/sold
Transferee or Purchaser Consideration $ Date
Attach a separate sheet for additional transfers and/or sales.
10. Was there a written partnership agreement in effect at the time of the decedent's death? DYes DNo
If yes, provide a copy of the agreement.
11. Was the decedent's partnership interest sold? DYes DNo
If yes, provide a copy of the agreement of sale, etc.
12. Was the partnership dissolved or liquidated after the decedent's death? DYes DNo
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
13. Was the decedent related to any of the partners? DYes DNo If yes, explain
14. Did the partnership have an interest in other corporations or partnerships? DYes DNo
If yes, report the necessary infonnation on a separate sheet, including a Schedule C-1 or C-2 for each interest.
,
THE FOllOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE I
A. Detailed calculations used in the valuation of the decedent's partnership interest. I
B. Complete copies of financial statements or Federal Partnership Income Tax retums (Form 1065) for the year of death and 4 preceding ye4rs.
C. If the partnership owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate apprai$a1s have been
secured, attach copies.
D. Any other infonnation relating to the valuation of the decedent's partnership interest.
STFPA42021F.7
II
. REV-15/fEX...(1-97)(I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
ESTATE OF
S. LOUISE SHELLEY
FILE NUMBER
2104-1155
All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1.
VAWE AT DATE
OF DEATH
STFPA42021F.8
TOTAL (Also enter on line 4, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
o
. REV-15'l8 EX + (1-97)(1)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
RLE NUMBER
2104-1155
ESTATE OF
S. LOUISE SHELLEY
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 VA~UE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
2
3
4
5
6
7
8
9
10
11
12
13
14
PSECU ACCOUNT NUMBER 0183122724 STATEMENT ATTACHED
ACCRUED DIVIDEND ON ITEM NUMBER 1
WAYPOINT BANK ACCOUNT NUMBER 9600007874 000
STATEMENT ATTACHED
ACCRUED INTEREST ON ITEM NUMBER 3
WAYPOINT BANK ACCOUNT NUMBER 20030981 IBA STATEMENT
ATTACHED
ACCRUED INTEREST ON ITEM NUMBER 5
CITIZENS BANK ACCOUNT NUMBERS 610070-111-5, 610070-
635-4, 6140-204879 STATEMENTS ATTACHED
ACCRUED INTEREST ON ITEM NUMBER 7
SAFE DEPOSIT BOX/COINS
HOUSEHOLD FURNISHINGS
PATRIOT NEWS SUBSCRIPTION REFUND
IRS TAX REFUND 2004
COMMONWEALTH OF PA TAX REFUND 2004
THEODORE SHELLEY TRUST INTEREST AND DIVIDENDS ID #
25-6771249 - STATEMENT ATTACHED
123,245
113
102,835
79
40,574
2
26,783
1
3,500
12,500
57
12,573
1,290
2,323
STFPA42021F.9
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
325,875
REV-I5Qfl EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
S. LOUISE SHELLEY
FILE NUMBER
2104-1155
If an asset was made joi nt withi n 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. W. MICHAEL NAILOR
651 FIFTH STREET
NORTHUMBERLAND, PA 17857
SON
B.
c.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY '10 OF DATE OF DEATH
ITEM FOR JOINT MADE Irclude name of firarcial institution and bark accOllll nllTber or similar identifying runber. DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST OECEDENTSINTEREST
1. A. 1995 SERIES HH BONDS - FORM PD F 4000 97,000 50 48,500
E ATTACHED 0
2 A 1995 ACCRUED INTEREST ON ITEM NUMBER 1 158 50 79
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
TOTAL (Also enter on line 6, Recapitulation) $ 48,579
(If more space is needed, insert additional sheets of the same size)
STF PA42021 F.l 0
: REV-15?;l EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
S. LOUISE SHELLEY
RLE NUMBER
2104-1155
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side ofthe REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY %OF
ITEM INClUDE ll-iE NAME OF ll-iE TRANSFEREE, ll-iEIR RElATIONSHIP TO DECEDENT AN) Tff:: DATE DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
NUMBER OF TRANSFER. ATTACH A COPY OF ll-iE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE)
1. RELIASTAR LIFE INSURANCE COMPANY 109,234 100 109,234
CONTRACT NUMBERS SCL01082751MNS, 0
SCLS01092699KNS STATEMENT ATTACHED 0
2 GE CAPITAL ASSURANCE POLICY NUMBER 118,847 100 118,847
0000674025 STATEMENT ATTACHED 0
3 LIFE AND ANNUITY CLAIMS CONTRACT 191,399 100 191,399
NUMBER GA206165 STATEMENT ATTACHED 0
4 AMERICAN INVESTORS LIFE INSURANCE 127,712 100 127,712
ACCOUNTS 342881, 378390, 447105 0
STATEMENT ATTACHED 0
5 SUNAMERICAN FINANCIAL CONTRACT 150,394 100 150,394
NUMBER A634051798D STATEMENT ATTACHE) 0
6 ACCRUED INTEREST ON ITEM NUMBER 5 267 100 267
7 TRANSAMERICA LIFE AND ANNUITY NUMBER 15,052 100 15,052
26254822 STATEMENT ATTACHED 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
TOTAL (Also enter on line 7, Recapitulation) $ 712,905
(If more space is needed, insert additional sheets of the same size)
SIT PA42021 F.11
.. REV-15T' EX + (1-97)(1)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
S. LOUISE SHELLEY
FILE NUMBER
2104-1155
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
1.
FUNERAL EXPENSES:
FUNERAL SERVICE EXPENSES
B.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s) W. MICHAEL NAILOR
Social Security Number(s) / EIN Number of Personal Representative(s)
StreetAddress 651 FIFTH STREET
City NORTHUMBERLAND State PA Zip 17857
Year(s) Commission Paid: 2 0 0 5
Attorney Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach el<planation)
1.
2.
3.
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. REGISTER OF WILLS
8 HOSPICE CARE
9 POSTAGE EXPENSE
10 REAL ESTATE TAXES
11 APPRAISAL FEE
12 HOMEOWNER'S INSURANCE
13 WATER EXPENSE
14 TELEPHONE EXPENSE
15 HEATING OIL EXPENSE
16 ELECTRIC EXPENSE
17 CABLE EXPENSE
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
STF PA42021 F.12
AMOUNT
1,166
50,000
5,000
521
500
31
3,122
300
355
122
185
1,190
163
353
$ 63,520
.. REV-1Stl EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
S. LOUISE SHELLEY
ALE NUMBER
2104-1155
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
IAMOUNT
FUNERAL EXPENSES:
1.
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
B.
Name of Personal Representative(s)
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
2.
3.
City
Year(s) Commission Paid:
Attorney Fees
Family Exemption: (If deoedent's address is not the same as claimant's, attach explanation)
State
Zip
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Zip
4.
Probate Fees
5.
kcountant's Fees
6.
Tax Return Preparer's Fees
7.
18
19
SEWER & TRASH COLLECTION EXPENSES
MAINTENANCE EXPENSES
324
188
,
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
STF PA42021 F.12
I!
. AEV-151j EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
S. LOUISE SHELLEY
ALE NUMBER
2104-1155
Include unreimbursed medical expenses.
ITEM
NUMBER
1.
DESCRIPTION
AMOUNT
STF PA42021 F.13
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
o
: REV-151fl EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENERCIARIES
II
ESTATE OF
S. LOUISE SHELLEY
FILE NUMBER
2104-1155
RELATIONSHIP TO DECEDENT
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s)
1. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers
under Sec. 9116 (a) (1.2)]
W. MICHAEL NAILOR
1. 651 FIFTH STREET
NORTHUMBERLAND, PA 17857 SON
AMOUNT OR SHARE
OF ESTATE
100% RESIDUE
ENTER DOLLAR 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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. WILLARD WATERMAN MEMORIAL COURT NO 54 ORDER OF AMARANTH
2 STEADFAST CHAPTER OF EASTERN STAR
3 MECHANICSBURG FIRE DEPARTMENT
4 MECHANICSBURG AREA MEALS-ON-WHEELS
5 MECHANICSBURG AREA SCHOOL DISTRICT
6 MECHANICSBURG AREA PUBLIC LIBRARY
7 FIRST UNITED METHODIST CHURCH
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
STFPA42021F.14
5,000
10,000
5,000
5,000
10,000
5,000
20,000
60,000
: REV-151;l EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE K
UFE ESTATE, ANNUITY
& TERM CERTAIN
(Check Box 4 on Rev-1500 Cover Sheet)
ESTATE OF
FILE NUMBER
S. LOUISE SHELLEY 2104-1155
This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death
prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit.
Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or $fter 5-1-89.
Indicate the type of instrument which created the future interest below and attach a copy to the tax return.
D Will D Intervivos Deed of Trust D Other
LIFE ESTATE INTEREST CALCULATION I
NAME(S) OF NEAREST AGE AT TERM OF YEARS lifE ESTATE IS
LIFE TENANT(S) DATE OF BIRTH DATE OF DEATH PAYABUE
o Ufe or 0 Term ofl Years
o Life or 0 Term o~ Years
o Ufe or 0 Term o~ Years
o Ufe or 0 Term o~ Years
1. Value of fund from which life estate is payable $
2. Actuarial factor per appropriate table
Interest table rate - 03 1/2% 06% 010% o Variable Rate %
3. Value of life estate (Line 1 multiplied by Line 2) $
I
ANNUITY INTEREST CALCULATION II
NAME(S) OF NEAREST AGE AT TERM OF '(EARS
ANNUITANT(S) DATE OF BIRTH DATE OF DEATH ANNUITY IS ~AYABLE
o Life or 0 Term of Years
o Ufe or 0 Term of Years
o Ufe or 0 Term of Years
o Ufe or 0 Term of Years
1. Value of fund from which annuity is payable $
2. Check appropriate block below and enter corresponding (number)
Frequency of payout - o Weekly (52) OBi-weekly (26) o Monthly (12)
o Quarterly (4) o Semi-annually (2) o Annually (1) o Other ( )
3. Amount of payout per period $
4. Aggregate annual payment, Line 2 multiplied by Line 3 0
5. Annuity Factor (see instructions)
Interest table rate 031/2% 06% 010% o Variable Rate %
6. Adjustment Factor (see instructions)
7. Value of annuity - If using 3 1/2%, 6%, 10%, or if variable rate and period payout is at end of period,
calculation is: Line 4 x Line 5 x Line 6 $
If using variable rate and period payout is at beginning of period, calculation is: ,
(Line4 x Line5 x Line6) + Line3 $ ,
I
!
NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on
Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13,
15,16 and 17.
(If more space is needed, insert additional sheets of the same size)
STF P A42021 F.15
: REV-164,ji' EX + (9-00)
SCHEDULE M
FUTURE INTEREST COMPROMISE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(Check Box 4a on Rev-1500 Cover Sheet)
ESTATE OF FILE NUMBER
S. LOUISE SHELLEY 2104-1155
This schedule is appropriate only for estates of decedents dying after December 12,1982.
This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoyment
cannot be established with certainty.
Indicate below the type of instrument which created the future interest and attach a copy to the tax return.
o Will 0 Trust 0 Other
I. Beneficiaries
NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO
NEARItST BIRTHDAY
1.
2.
3.
4.
5.
0. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9 months
of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises isuch
withdrawal right.
0 Unlimited right of withdrawal 0 Limited right of withdrawal
m Explanation of Compromise Offer:
IV. Summary of Compromise Offer:
1. Amount of Future Interest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
2. Value of Line 1 exempt from tax as amount passing to charities, etc.
(also include as part of total shown on Line 13 of Cover Sheet) ........... $
3. Value of Line 1 passing to spouse at appropriate tax rate
Check One 06%, 03%, 00% .......................... $
(also include as part of total shown on Line 15 of Cover Sheet)
4. Value of Line 1 taxable at lineal rate
Check One 06%, 04.5% . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $
(also include as part of total shown on Line 16 of Cover Sheet)
5. Value of Line 1 Taxable at sibling rate (12%)
(also include as part of total shown on Line 17 of Cover Sheet) ........... $
6. Value of Line 1 Taxable at collateral rate (15%)
(also include as part of total shown on Line 18 of Cover Sheet) ........... $
7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 0
(If more space is needed, insert additional sheets of the same size)
STF PA42021 F.16
.. REV.l64,G EX + (1-9?) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 0
ELECTION UNDER SEC. 9113(A)
(SPOUSAL DISTRIBUTIONS)
ESTATE OF ALE NUMBER
S. LOUISE SHELLEY 2104-1155
Do not complete this schedule unless the estate is making the election to tax assets under Section 9113 (A) of the Inheritance & Estate Tax Act.
If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust.
This election applies to the Trust (marital, residual A, B, By-pass, Unified Credit, etc.).
If a trust or similar arrangement meets the requirements of Section 9113 (A), and:
a The trust or similar arrangement is listed on Schedule 0, and
b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0,
then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust
or similar property trealed as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule
0, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is
equal to the amount of the trust or similar arrangement included as a taxable asset on Schedule O. The denominator is equal to the total value of theitrust or similar
arrangement.
PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's
surviving spouse under a Section 9113 (A) trust or similar arrangement.
DESCRIPTION VALLE
Part A Total $ 0
PART B: Enter the description and value of all interests included in Part A for which the Section 9113 (A) election to tax is being made.
DESCRIPTION VALLE
Part B Total $
(If more space is needed, insert additional sheets of the same size)
o
STF PA4202l F.17
II
~ :
~
I
LAST WILL AND TESTAMENT OF
S. LOUISE SHELLEY
I, S. LOUISE SHELLEY, of the Borough of Mechanicsburg, Cumberland County,
Pennsylvania, being of sound mind and memory, do make, publish and declare this my Last Will and
Testament, hereby revoking and making void any and all wills by me heretofore made.
FIRST:
I order and direct that all of my just debts and funeral expenses be paid by my
hereinafter named Executor as soon after my death as may be found convenient.
SECOND: I give the sum of FIVE THOUSAND ($5,000.00) DOLLARS to WILLARD
WATERMAN MEMORIAL COURT NO. 54, ORDER OF AMARANTH, absolutely.
THIRD:
I give the sum of TEN THOUSAND ($ 1 O,OOO:DO) DOLLARS to
STEADF AST CHAPTER OF EASTERN STAR, absolutely.
FOURTH: I give the sum of FIVE THOUSAND ($5,000.00) DOLLARS to
MECHANICSBURG FIRE DEPARTMENT, absolutely.
FIFTH:
I give the sum of FIVE THOUSAND ($5,000.00) DOLLARS to
MECHANICSBURG AREA MEALS-ON-WHEELS, absolutely.
SIXTH:
I give the sum of TEN THOUSAND ($10,000.00) DOLLARS to
MECHANICSBURG AREA SCHOOL DISTRICT, absolutely, for use and promotion of speech and
debate activities.
SEVENTH: I gIVe the sum of FIVE THOUSAND ($5,000.00) DOLLARS to
MECHANICSBURG AREA PUBLIC LIBRARY, absolutely.
EIGHTH: I give the sum of TWENTY THOUSAND ($20,000.00) DOLLARS to FIRST
:JL~_-L H0~
1 S."Louise Shelley -
II
,
UNITED METHODIST CHURCH of Mechanicsburg, Pennsylvania, absolutely.
NINTH:
I give, devise, and bequeath all the rest, residue and remainder of my estate,
real, personal and mixed, of whatever nature and wheresoever situate, which I may own or have the
right to dispose of at the time of my death unto my son, W. MICHAEL NAILOR, absolutely, ifhe
survives me. In the event that my son fails to survive me then I give, devise, and bequeath all the
rest, residue and remainder of my estate, real, personal and mixed, of whatever nature and
wheresoever situate, which I may own or have the right to dispose of at the time of my death unto
FIRST UNITED METHODIST CHURCH of Mechanicsblirg, Pennsylvania, absolutely.
TENTH: I hereby nominate, constitute and appoint my son, W. MICHAEL NAILOR, ias
;
Executor of this, my Last Will and Testament, and I do direct that no bond shall be required of suth
Executor hereunder. My said Executor shall ~ave full power at his discJetion to. do any and all things
necessary for the complete administration of my estate, including the power to sell at public ior
private sale and without order of Court, any real or personal property belonging to my estate, andlto
compound, compromise or otherwise to settle or adjust any and all claims, charges, debts and
demands, whatsoever, against or in. favor of my estate, as fully as I could do if living.
In the event that my son, W. MICHAEL NAILOR, does not survive me or fails to qualify,
then I nominate, constitute and appoint W ACHOVIA BANK, as the alternate Executor. Said
alternate Executor shall have all of the powers, privileges, duties and immunities as hereinbefdlre
more fully set forth for my original Executor.
IN WITNESS WHEREOF, I, S. LOUISE SHELLEY, the above Testatrix have set my hand
and seal to this my Last Will and Testament, which consists of three (3) pages, to each ofwhidh I
lY"U..~~
. Louise Shelley
I~JL&~
2
/
\.-'
II
have affixed my signature this
If J'Y
l-I -
,2001.
riD Ii t- ("'1' G l:- !~
day of
~~~..~
/
S. tOUlse Shelley
~7
(SEAL)
Signed, sealed, published and declared by the above named Testatrix 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 subscribed our names as witnesses.
3
II
.
,
Borrower/Client Michael NailorfExecutoif File No. 05-139
Pronertv Address 304 West Main Street
Citv Mechanicsbufl>' Countv Cumberland State P A Zin Code 17055-3201
Lender N/A
TABLE OF CONTENTS
Services Invoice ... ...... ....."............................... .................................... .............................................................................
Cover Page ....................... ........................ ........................." ...................... ..........................................
Cover Letter ... "'" ........... ............. ...... . "'" ........ ................... ......... ........."...... ...... .............. ............ ...... ............. ................... ................."........".......".......
Summary of Salient Features '"'''''''''''''''''''''''' ...................... ..............................................................................................................".......................... 4
URAR ........... ...... ....... ............ ...... .."............ ......... ...... ............ ......... ... .................. ................... ...... ...... ............ ............. ...... ............ ....... ............ ............... 5
Additional Comparables 4-6.... ............................................. .."...................................................................................................... 7
General Text Addendum ....... .................................................. ......................................................................................................................................... 8
Building Sketch [Page - 1) ... ........................................................................................................... ................................................................................ 10
Subject Photos ... ..... ............"..... ............ ..... .......... ........... ...... ................... ""'" ...... ............. ............. ............ ............. ....... ............ ........................ ........... 11
Statement of Limtting Conditions ........................................................................... .......................................................................................................... 12
Comparable Photos 1-3..... .............................................................. ................................................................................. ............................................. 14
Comparable Photos 4-6.... ...... ................................. ........................................................................ "'"'''''''''''''''''''''''''''''''''''''''''''' 15
Comparable Sales Map .... ................................................................ ............................ ..................................... ........................................... 16
Site Map.... """"""'"'''''''' ............................. .... ..................................... ....................... ................................ 17
Deed ...... ........................ ......................................... ............................. 18
Tax Assessor's Map ........... .................................... ...................... "'''''....... 19
Form TOCNP - 'TOTAL for Windows' appraisal software by a la mode, inc. - 1-800-ALAMODE
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Forrester & Co. Real Estate Appraisers
Form GAl - 'TOTAL tor Windows' appraisal software by a fa mode, inc. - 1-800-AlAMODE
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Rle No. 05-139
March 31, 2005
Forrester & Co. Real Estate Appraisers
359 East Market Street
York, PA. 17403
Michael Nailor
651 Fifth Street
Northumberland, P A 17857
Re: 304 West Main Street, Mechanicsburg, P A. 17050-3201
Owner: Nailor, Stanley G. & Sara L. (Deceased)
Dear Mr. Nailor:
Pursuant to your request, [ have prepared a SUMMARY APPRAISAL REPORT ofthe above
referenced property which is also captioned in the "Summary of Salient Features" which foHows.
The accompanying report is based upon a site inspection of the improvements; investigation of the
subject neighborhood area of influence; and, review of sales, cost and income data for similar
properties. This report is for the sole and exclusive use of the client, Michael Nailor, Executor of
the Sara L. Nailor estate. The intended purpose of this appraisal report is to determine the
retrospective market value of the above referenced property as of the date of death of Mrs. Sara
Nailor on December 20, 2005 for estate tax purposes. No third parties are authorized to rely upon
this report without the express written consent of the appraiser.
The statements of fact contained in this report are true and correct. The reported analyses,
opinions, and conclusions are limited only by the reported assumptions and limiting conditions,
and are my personal, impartial, unbiased professional analysis, opinion and conclusion. I have no
present or prospective interest in the property that is the subject of this report, and no personal
interest with respect to the parties involved. My engagement for this assignment was not
contingent upon developing or reporting predetermined results and my compensation for
completing this assignment is not contingent upon the development or reporting of a predetermined
value or direction in value that favors the cause of the client, the amount of the value opinion, the
attainment of a stipulated result, or the occurrence of a subsequent event directly related to the
intended use of this appraisal.
The use of this report is subject to the requirements of the Appraisal Institute relating to review by
its duly authorized representatives. This appraisal has been made with particular attention paid to
applicable value-influencing economic conditions and has been processed in accordance with
nationally recognized appraisal guidelines and in conformity with the Code of Professional Ethics
and the Uniform Standards of Appraisal Practice. The value conclusion stated herein is "as of' the
effecti ve date, as stated in the body of the appraisal. [ have made a personal inspection of the
property that is the subject of this report and have not received significant professional assistance
from any individuals. The appraiser is not a home inspector. This report should not be relied upon
to disclose any conditions present in the subject property. The appraisal report does not guarantee
that the property is free of defects. A professional home inspection is recommended. This report
is invalid as an appraisal without the inclusion of all pages denoted on the Table of Contents.
Please do not hesitate to contact me if I can be of additional service to you, and thank you for your
business.
Respectfully,
~(a~
Vicki B. Forrester, Broker
P A State Certified General Appraiser
GA-001580-L
Form OCVR - "TOTAL for Windows" appraisal software by a fa mode, in<:. - 1-800-ALAMOOE
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Subject Address
Legal Description
City
II
SUMMARY OF SALIENT FEATURES
304 West Main Street
Deed Book 17-D, Page 259
Mechanicsburg
Census Tract
Map Reference
Saie Price
Date of Sale
Borrower / Client
Lender
Size (Square Feet)
Price per Square Foot
Location
Age
Condition
Total Rooms
Bedrooms
Baths
Appraiser
Date of Appraised Value
Final Estimate of Value
17055:3201
3240-0114.00
18-H7
$ N/A
N/A
Michael Nailor (Executor)
Michael Nailor (Executor)
2,153
Average-suburb
43 +/-
Average
7
4
1.5
Vicki B. Forrester, P A State Certified General Appraiser
December 20,2004 (Retrospective as of the Date of Death)
$ 157,000
Form SSD - 'TOTAL for Windows' appraisal software by a la mode, inc. - 1-8DO-ALAMODE
II
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Forrester & Co. Real Estate Appraisers
Nailor
fileNo. 05-139
Prooertv Address 304 West Main Street Citv Mechanicsbun! State P A liD Code 17055-320 I
Leaal Descriotion Deed Book 17-D Pal!e 259 Counlv Cumberland
Assessor's Parcel No. 23-0567-071 Tax Year2005 R.E. Taxes ~ 2 890.84 S""cial As<essmonts t 0.00
Borrower Michael Nailor (Executor) Current Owner $a;ifl:lt~:Slliillc:*!ffi & Sara L. Occunant 1'1 Owner I' Tenant IXI Vacant
. Prooertv riahts aDO raised rx Fee Simole I Leasehold Pro'ect Tvoe I PUD Condominium ~UDNA onlvl HOA ~ 0.00 /Mo.
Neiahborhood Dr Proiect Name Mechanicsburl!Borouoh MaD Reference 18-H7 Census Tract 3240-0114.00
Sale Price $ N/A Date of Sale N/A Oescrintion and $ amount af loan charne<'concessians to be oaid bv seller N/ A
Lender/Client Michael Nailor (Executor) Address 651 Fifth Street NorthumberlaIlrl P A 17857
Aooraiser Vicki B. Forrester ORI Broker Address 359 East Market StreeL York PA 17403
Location U Urban ~ Suburban U Rural Predominant _~n~e lam i1y hoUSI~ Present land use % Land use change
rRI AG
Buiil up o Over 75% !:8:1 25-75% 0 Under 25% occupancy (000) J,rs) One family ---2L !:8:1 Not likely o Likely
Growth rate o Rapid !:8:1 Stable o Slow [gJ Owner ~ Low~ 2-4 family ----L- o In process
Property values !:8:Ilncreasing o Stable o Declining o Tenant I ~ Hi h 100+ Multi-family _ To:
Demand/supply g ~hortage ~ In balance R ~ver supply [gJ Vacant (0-5%) Predominant I'jfyj;~i4 Commercial 15
Marketino time Under 3 mos. 3-6 mos. Over 6 mos. H Vaclover5%' 125-175 45-75 VacantlRec 25
Nate: Race and the racial composition 01 the neighborhood are not appraisal lactors.
Neighborhood boundaries and characteristics: The annraiser has indicated the nei"hborhood boundaries on a nei"hborhood man which is
included in the addendum of this renort.
- Factors that affect the marketability of the properties in the neighborhood (proximity to employment and amenities, employment stability, appeal to market etc.):
The subiect has easy access to all necessarv sunnortinll facilities includin" schools nublic narks transnortation shonnin" and
" nlaces ofworshin. Emnlovrnent stability is "ood due to the State Canitol at Harrisbur". the Naw Sunnlv Denot in
Mechanicsbur". the Armv Sunnlv Denot in New Cumberland and the exnandinl! West Shore Area. Ernnlovrnent is located
within a 5-15 minute drive. Steadv orice increases and multinle listinl! statistics demonstrate a l!ood market demand for this
area. The subiect is located in an older established borouoh of averal!e to l!ood oualitv homes known as (See Addendum)
Market conditions in the subject neighborhood Qncluding support for the above conclusions related to the trend of property values, demand/supply, and marketing time
__ such as data on competitive properties for sale in the neighborhood, description of the prevalence of sales and financing concessions, etc.):
The search of countv tax records and the multinle listing service showed that nrices were increasinl!. The MLS indicates that
the tvoical oronertv sold within 3 months due to an increase in demand snurred bv the record low interest rates. Sufficient
financino was available due to the decrease in the cost ofmortl!age moneY which increased the level ofaffordabilitv. Mortl!al!e
funds were readilv available from a variety of sources with conventional fixed rate 00 vr term) loans averacrino 5.5% to 6%
with un to 3 noints. Sellers are not reouired to offer sales or financing concessions however seller assistance was occurrinl!.
- Projectlnlormationfor PUDs (If applicable) - -Is the developer/builder in control of the Home Owners' Association (HOA)? U Yes TI No
Approximate total number of units in the subject project N/ A Approximate total number of units for sale in the subject project N/ A
Describe common elements and recreational facilities: N/A
Dimensions 57.00' x 185.00' x 57.00' x 185.00' or 10 545 sa. ft. Topography ({jJ lrrade level
Site area .242 acre Corner Lot 0 Yes [gJ No Size Tvnical for area
Specific zoning classification and description RM - Residential Medium Densitv Shape Rectan=lar
Zoning compliance !:8:1 Legal J? Legal nonconfning (Grandfathered use) 0 Illegal o No zoning Drainage Annears adeauate
Hinhest & best use as imnroved: Present use Other use leJ(olainl View A vera<>e street
UliInies Public Other Off-site Improvements Type Public Private Landscaping Averalle for area
Electricity [gJ 100 amo Street Macadam !:8:1 0 Driveway Surface Brick/Concrete (Shared)
Gas 0 Curb/gutter Concrete !:8:1 0 Apparent easements Tvoical Utility
Water [gJ Sidewalk Concrete 0 !:8:1 FEMA Special Flood Hazard Area o Yes !:8:1 No
Sanitary sewer !:8:1 Street lights Yes ~ R FEMA Zone X Map Date 3/3/1992
Storm sewer I'X1 Allev N/A FEMA MaD No. 420362 0005 0
Comments (apparent adverse easements, encroachments, special assessments, slide areas, iIIegai or legal nonconforming zoning use, etc.): This nronertv was
subiect to normal utilitv easements for teleohone electric etc. There were no known or annarent adverse encroachments soecial
assessments or other adverse conditions noted. The sub'ect has a shared access drive with the neiohbor adioininl! on the west.
GENERAL DESCRIPTION EXTERIOR DESCRIPTION FOUNDATION BASEMENT INSULATION
No. of Units One Foundation Concrete Blk. Slab N/A Area SQ. Ft. 2153 Roof _0
No. of Stories One Exierior Walls Brick Crawl Space N/ A % Finished Unfinished Ceiling _ 0
Type (Det./Att.) Detached Roof Surface Asnhlt Shn<>l Basement Full Ceiling truss-nlaster Walls _ 0
Design (Style) Ranch Gutters & Dwnspts. Aluminum Sump Pump Floor Drain Walls Conc Blk Floor _0
Existing/Proposed Existinl! Window Type Wood SH Dampness Water noted Roor Concrete None _ 0
Age (Vrs.) 43 +/- Storm/Screens Storm Units Settlement No Evidence Outside Entry N/ A Unknow!!....-- !:8:1
Effective Ane /Vrs.\ 30 +/- Manufactured House N/ A Infestation No Evidence R-factors unknown
ROOMS Faver Livina Dinino Kitchen Den Familv Rm. Rec. Rm. Bedrooms # Baths Laundrv Other Area So. Ft.
. Basement 2153
Level 1 x I I &Brkf I 4 1.5 x 2153
Level 2
-
. Finished area above nrade contains: 7 Rooms' 4 Bedroomlsl: 1.5 Bath's' 2 153 S uare Feet of Gross Livino Area
INTERIOR MaterialS/Condition HEATING KITCHEN EQUIP. ATTIC AMENITIES CAR STORAGE:
Floors W ood- Vinyl! A Vll Type HW Refrigerator 0 None 0 Fireplace(s) # LR./LL [gJ None 0
Walls Plaster/ A VI! Fuel Oil Range/Oven !:8:1 Stairs 0 Patio Front Conc !:8:1 Garage # of cars
TrilTl'Finish Stnd-Pntd WdlAvl! Condition A veral!e Disposal 0 Drop Stair !:8:1 Deck 0 Attached 2 Car
Bath Roor Ceramic Tile/Avo COOUNG Dishwasher 0 Scuttle 0 Porch 0 Detached
Bath Wainscat Ceramic Tile/ A yo Central Yes FanIHood [gJ Roor 0 Fence 0 Buitt-In
Doors Int: Wood Other N/A Microwave 0 Heated R Pool 0 Carport
Ext: Wood Condition A veral!e Washer/Drver n Finished rl Drivewav 2 Car
Additional features (special energy efficient items, etc.): Livin room with masOnry firenlace' whole house ventilation fan' front concrete
natio' water softener' lower level (unfinished' with firenlace' and attached two car oaraoe with electric l!araoe door o""'"er.
Condition of the improvements, depreciation (physical, functional, and extemaQ, repairs needed. Quality of construction, remodeling/additions, etc.: There are no
anoarent functional or external inadeauacies. The construction oualitv is tvnical for the area and nei"hborhood. Based unon the
al!e maintenance condition and comnarison to comnetino neil!hborhoods the estimated effective al!e is eaual to the actual aQ"e.
Physical denreciation due to al!e. The dwellino is in average condition for a home of this aoe with older style kitchen and bath.
Adverse environmental conditions (such as, but not limited to, hazardous wastes, toxic substances, etc.) present in the improvements, on the site, or in the
immediate vicinity of the subject property.: There are no known or annarent adverse environmental conditions that would negativelv
imoact on the value of the nrooertv. This house is of an al!e where lead based paint may be nresent. The (See Addendum)
UNIFORM RESIDENTIAL APPRAISAL REPORT
Freddie Mac Form 70 6/93
PAGE 1 OF 2
Form UA2 - "TOTAL lor Windows' appraisal software by a la mode, inc. - 1-8oo-ALAMODE
Fannie Mae Form 1004 6193
Nailor
UNIFORM RESIDENTIAL APPRAISAL REPORT FileNo. 05-\39
ESTIMATED SITE VALUE. .........= $ 30 000 Comments on Cost Approach (such as, source of cost estimate. site vaiue,
ESTIMATED REPRODUCTION COST-NEW-OF IMPROVEMENTS: square foot calculation and for HUD, VA and FmHA, tl1e estimated remaining
Dwelling 2.153 Sq. Ft. @$ ~ = $ 184,082 economic life of the property): The site value is based unon a
2153 Sq. Ft. @$ ~ = 29.066 review of recent land sales. Cost factors develoned from
Annliances Fireplaces Patio etc. = 12,300 local contractors and Marshall Valuation Services
Garage/Carport ~ Sq. Ft. @$ 26.00 = 15,964 verified by appraiser's files and local cost data. Physical
Total Estimated Cost New.. ..... . = $ 241 ,412 denreciation due to age and based unon the age/life
Less Physical Functional Extemal method. No functional obsolescence or economic
Depreciation 120,7061 I =$ 120 706 obsolescence observed. The estimated remaining
Depreciated Value of Improvements ....... . ........ ......... ... =$ 120706 economic life is 30+ years.
'As-is' Value of Site Improvements.. .. -$ 10 000
INDlCATEDVALUEBYCOSTAPPROACH.......RO'UNDED. ~~ 160,700
ITEM I SUBJECT COMPARABLE NO.1 COMPARABLE NO.2 COMPARABLE NO. 3
304 West Main Street 3 York Circle 3468 Trindle Road 38 Oakwood Avenue
Address Mechanicsburl! Mechanicsburl! Mechanicsburg Mechanicsburg
Proximity to Subect 0.62 miles 4.25 miles ~
Sales Price It N/A ~ 16490~~
PricplGrosslivinnArea It rtJ ~ 98.44 rtJ~~ 83.66 101.30 rtJ~
Data and/or Inspection MLS; Exterior Insp; Agent MLS; Exterior Insp; Agent MLS; Exterior Insp; Agent
Verification Source Court House Records Court House Records Court House Records
VALUE ADJUSTMENTS _DESCRIPTION DESCRIPTION: +(-)$ Adiust DESCRIPTION: +{ -\$ Must. DESCRIPTION: +(:')$ Adiust.
Sales or Financing Conventional Conventional FHA
Concessions No Concession No Concession Costs $3900
Date of SalefTime 07120/04: 03/31/04: 09/30/04:
location A verap"e-suburb Enual : Eaual : Sunerior:
LeaseholdlFoe Simole Fee Simnle Fee Simnle: Fee Simnle: Fee Simnle :
Site .242 acre .83 acre/Eaual : .17 acrelEaual : .38 acre/Eaual
View Avera"e street Eaual : Eaual Eaual
Desinn and Anneal Ranch/ Average Ranch/Eaual Ranch/Eaual RanchlEnual
QualiN of Construction Brick/Average Alum-BricklEal : AluminurnlEol Brick/Eoual
Ane 43 +/- 43 +/- : 52 +/- 40 +/_
Condition A venw:e Eaual : Eaual : Suoerior:
Above Grade Total 'Bdrms' Baths Total :Bdrms: Baths: Total :Bdnms: Baths: Total :Bdrms: Baths:
Room Count 7 4: 1.5 7: 3 : 1.5 : 7 : 3 : 2: -2,000 7: 3 2
Gross livinn Area 2 153 Sn. Ft. 1 534 Sn. Ft.: +7400 I 971~ Ft.: +2200 I 617 Sn. Ft.:
Basement & Finished Full Full Full Full
. Rooms Below Grade Unfinished Recreat.ion Rm: -2 000 Unfinished Fam RmlBath
Functional Utilitv Averap"e Averap"e: Average: Averal!e
. Heatinn/Coolinn OHW/Central OHWBB/Centr: OHWBB/Centr : EHP/Central:
Enemv Efficient ttems Storm Units Thermonanes: Storm Units: ThermoDanes :
Garaoe/Carnort 2 Car Att Gar 2 Car Garage : I Car Gar/C~mrt : 2 Car Garal!e :
Porch, Patio, Deck, Front Patio Patio Patio Front Porch
FirMlacelsl etc. Two Firenlaces Two Firenlaces Firenlace +2000 Firenlace
Fence Pool etc. NI A NI A : Secur\iV Svstem : -2 000 NI A
: :
NetAdi.ltota/l _-:$ 54001lli:~ 200ili('$
Adjusted Sales Price
of Comnarable 156400 ,Is 165 \00 157200
Comments on Sales Comparison (including the subject property's compatibility to the neighborhood, etc.): Your annraiser searched throiWhout the
surroundinl> market area for cornoarable sales of ranch styled homes that sold within the last year considered adeauate for
comparison with the subiect ~ronertv. After a thoroul!h-search of all available market data the closed sales disDlayed and
analyzed were considered to be the best indicators of value. Adjustments were made to the comnarable sales to reflect the
market reactions to those items ofsi<mificant variation between the subiect and co~narables. Cornoarable sale #1 is located
iust north of the subiect on the Mechanicsburl! Boroul!h line. The dwellinp" was described bv the listinl! agent (See Addendum)
ITEM SUBJECT COMPARABLE NO.1 COMPARABLE NO.2 COMPARABLE NO.3
Date, Price and Data None None None None
Source, for prior sales NI A NI A N/ A N/ A
within vear of aooraisal Crt Hs. Record Court House Records Court House Records Court House Records
Analysis of any current agreement of sale, option, or listing of SUbject property and analysis of any prior sales of subject and comparables within one year of the date of appraisal:
Prior sales of the comnarable nronerties as detailed above. No aPTeements of sale. The subiect nronertv was not listed or
I rending sale as of 12/20104' ann has not transferred within the last three vears.
INDICATEDVALUEBYSALESCOMPARISONAPPROACH...... ..................... ..... ............. ............................................... $
INDICATED VALUE BY INCOME APPROACH lit Aoolicable\ Estimated Market Rent $ N/ A "IMo. x Gross Rent Muttinlier N/ A = $
This appraisal is made ~ 'as is' TI subject to the repairs, alterations, inspections Dr conditions listed below U subject to completion per plans & specffications.
Conditions of Appr~sal: No warranN of the annraised is p"iven or imnlied. No liabilitv is assumed for the structural or mechanical
elements of the orone~
Final Reconciliation: Greatest weight is lriven to the Sales Comnarison Approach as it reflects the tvnical reactions ofbuvers and
sellers in the marketnlace. The Cost AODroach SUDnorts the final value conclusion. Due to the lack of oualitv rental data the
Income Annroach is not annronriate.
The purpose of this appraisal is to estimate the market value of the real property that is the subject of this report, based on the above conditions and the certification. contingent
and limiting conditions, and market value definition that are stated in tile attached Freddie Mac Fonm 439/FNMA fonm 1oo4B (Revised June 1993 ).
I (WE) ESTIMATE THE MARKET VALUE, AS DEANED, OF THE REAL PROPERTY THAT IS THE SUBJECT OF THIS REPORT, AS OF 12/10/04
(WHICH IS THE DATE OF INSPECTION AND THE EFFECTIVE DATE OFTHIS REPORT) TO BE $ 157 , 000
APPRAaB: n.. SUPERVISORY APPRAISER (ONLY IFREOOIRED):
SinnatUllr"\a 'A 1-: I .. _ _ a.. . Sianature
Name . e Name
Date Report Sioned Mar~h 31. 2005 Date R.nort Sinned
State Certification # GA -001580- L State P A State Certification #
Or State license # State Or State license #
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-5 000
-4 000
-2,000
+6 400
-4000
+2000
6600
157 000
k8J Did 0 Did Not
Inspect Property
Freddie Mac Fonm 70 6193
PAGE 2 OF 2
Fonm UA2 - 'TOTAL for Windows' appraisal software by a la mode, inc. - f -8oo-ALAMODE
Fannie Mae Fonm 1004 6-93
State
State
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UNIFORM RESIDENTIAL APPRAISAL REPORT
MARKET DATA ANALYSIS
, I
!!,.ese recent sales 91 properties ar~gf~~~~':milar and proximate to subject and have been considered In'i}~~!e mar . Jhe description Includes a dOI~ adjustment, reflecting
market reaction to those items of sign variation between the subiect and comparable properties. If a . . in the comparable property is superior to, or more
favorable than, the subject property, a (.) adjustment is made, thus reducil)g the indicated value of significant item in the comparable is inferior to, or less
favorable than, the subject property, a plus +) adjustment is made, thus increasing the indicated value of t su Ject.
ITEM I SUBJECT
304 West Main Street
Address
Proximitv to Subiect
Sales Price I s
Price/Gross Livina Area Is
Data and/or Inspection
Verification Sources
VALUE ADJUSTMENTS
Sales or Financing
Concessions
Date of SalelTime
Location
LeaseholdlFee Simole
Site
View
Desion and Anneal
Dualitv of Constructinn
Aoe
Condition
. Above Grade
Room Count
Gross Livina Area
Basement & Finished
Rooms Below Grade
Functional Utllitv
Heatina/Coolino
Enemv Efficient ttems
GaraaelCaroort
Porch, Patio, Deck,
Fireplacelsl. etc.
Fence Pool etc.
DESCRIPTION
A verage.suburb
Fee Simole
.242 acre
Average street
Ranch/Average
Brick! Average
43 +/.
Average
Total : Bdrms: Baths
7 : 4 : 1.5
2 153 Sa. Ft.
Full
Unfinished
Average
OHW/Central
Storm Units
2 Car At! Gar
Front Patio
Two Fireplaces
N/A
COMPARABLE NO. 4
511 Cocklin Street
MechanicsburQ'
lMmiLes_
N/A~:":'I' ~
rtJ $ 79.65rtJl<;,Y;!t,'m.~ $
MLS; Exterior Insp; Agent
Court House Records
DESCRIPTION : + (-)$ Adiust
Cash
No Concession
08/19/04
Superi or
Fee Simple
.27 acre/Eaual :
Eaual
Ranch/Eoual
Brick.FramelE
31 +/- :
Equal :
Total :Bdrms: Baths:
7 : 3 : 2.5 :
2 260 Sa. Fr. :
Partial
Unfinished
A veraQ'e
EBB/Central :
Storm Units
I Car Garage :
Patio
Fireplace
IG Pool
COMPARABLE NO. 5
rtJ
DESCRIPTION
+ (-)$ Adiust
-5 000
Total : Bdrms: Baths :
-4,000
-1300
So. Ft. :
+1000
.10 000
NetAdi.ftotal\ ~-:s
Adjusted Sales Pnce
of Comaarable I ~
Date. Price and Data None None .
Source for prior sales N/ A N/ A
within year of annrarsal Crt Hs. Record Court House Records
Comments:
Market Data AnalysIs 6-93
19300~$
160700~~
COMPARABLE NO. 6
rtJ
DESCRIPTION
: +(-)$ Adjust
Total: Bdrms: Baths :
So. Ft.:
jMt:
Form UA2.(AC) - "TOTAL for WindOWS. appraisal software by a la mode. inc. -l-800-ALAMODE
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Borrower/Client Michael Nailor (Executorf
pronl!rtv Address 304 West Main Street
City Mechanicsburl! Countv Cumberland State P A liD Code 17055-320 I
Lender N/A
Supplemental Addendum
File No 05-139
. Neil!hborhood Marketabilitv Cont'd:
"Mechanicsburg" which provides a good environment for the house being appraised. Good property compatibility
and maintenance programs were observed throughout the immediate neighborhood. Highway accessibility is one
of the area's greatest assets with Route 114, Federal Route II, Route 641 (aka Main Street) and Interstate 76
located within a short drive. Main Street is the primary commuter corridor through Mechanicsburg and has a
heavier traffic flow than most surrounding secondary arteries. Commercial and multi-family uses are dispersed
throughout the borough which is common for older communities and does not adversely affect the subject's
marketability .
. Adverse Environmental Conditions Cont'd:
market does not penalize the property, but the client should be advised of its possible existence. It is assumed that
it is not present. If the client has a concern then a qualified expert should be contacted.
. Sales Comparison Approach Cont'd:
to be in average condition with new windows, hardwoods in most rooms and a finished recreation room on the
lower level. A basement adjustment reflects the superior fmished living area on the lower level. Dwelling square
footage as confirmed with tax assessment records, is inferior to the subject and a size adjustment was warranted.
This home was listed for sale at $155,000 and sold for $151,000 within 20 days with no seller concessions paid as a
condition to the sale. Comparable sale #2 is located on Trindle Road (aka Route 641) east of the Mechanicsburg
Borough. Information provided by the listing agent indicates the home was well maintained with and updated
electrical service, new carpet and an updated bathroom. Dwelling square footage as per tax record is slightly
inferior to the subject and a size adjustment was warranted. According to multiple listing records, this property
was offered for sale at $164,900 and sold for full price within 14 days with no seller concessions paid as a
condition to the sale. Comparable sale #3 is located in a residential neighborhood known as Webercroft which is
superior to the subject's location on a main artery. A location adjustment reflect's the subject's slightly inferior
location which has a heavier traffic flow. Information provided by the listing agent indicates this home was
updated with replacement windows, new heat pump, new electrical service, and a remodeled kitchen which is also
superior to the subject. A condition adjustment reflects the superior updates and renovations. Dwelling square
footage as confirmed with tax assessment records is inferior to the subject and a size adjustment was warranted.
Multiple listing records indicate the property was listed for sale at $159,900 and sold for $163,800 within 68 days
with the seller paying $3,900 toward the buyer's closing costs as a condition to the sale. Comparable sale #4 is
located in the nearby residential neighborhood known as Heritage Acres which is also a superior location.
Information provided by the listing agent indicates the home was in average condition with no significant updates
or renovations. The property had an inground pool which is superior to the subject. Dwelling square footage as
confirmed with tax assessment records is comparable to the subject and no size adjustment was warranted. This
home was listed for sale at $189,900 and sold for $180,000 within 3 days with no reported seller concessions.
A thorough search for comparable sales was made in an attempt to find sales which bracket the fmal value estimate
for the subject property. After consideration of locations, dates of sale, physical differences and special conditions,
in the appraiser's judgement, the comparables used are the best indicators of the subject's value. The comparable
sales were verified with the sources indicated and the appraiser was able to ascertain that there were no sales
concessions, special financing or other special considerations unless otherwise noted. All comparable sales were
considered equally in estimating the subject's fmal indicated market value.
. Supplemental Certifications Cont'd:
I certify that, to the best of my knowledge and belief:
- the statements of fact contained in this report are true and correct.
_ the reported analyses, opinions, and conclusions are limited only by the reported assumptions and
limiting conditions, and are my personal, impartial, and unbiased professional analyses, opinions
and conclusions.
_ I have no present or prospective interest in the property that is the subject of this report, and no
personal interest with respect to the parties involved.
_ I have no bias with respect to the property that is the subject of this report or to the parties involved
with this assignment.
_ My engagement in this assignment was not contingent upon developing or reporting predetermined
results.
_ My compensation for completing this assignment is not contingent upon the development or reporting
of a predetermined value or direction in value that favors the cause of the client, the amount of the
value opinion, the attainment of a stipulated result, or the occurrence of a subsequent event directly
Form TADD - 'TOTAL for Windows' appraisal software by a la mode, inc. -1-BOO-ALAMODE
II
..
Borrower/Client Michael Nailor (Executor)
Prooertv Address 304 West Main Street
Citv MechanicsbufQ: Countv Cumberland State P A Zio Code 17055-3201
Lender N/A
Supplemental Addendum
File No 05- 139
related to the intended use of this appraisal.
_ My analyses, opinions, and conclusions were developed, and this report has been prepared, in
conformity with the Uniform Standard of Profession Appraisal Practice.
_ I have made a personal inspection of the property that is the subject of this report.
~~~
Vicki B. Forrester, Broker
P A State Certified General Appraiser
GA-OO l580-L
Form TADD - "TOTAL for Windows' appraisal software by a la mode, inc. -1-800-ALAMODE
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,
Building Sketch (Page - 1)
Borrower/Client Michael Nailor (Executor)
Prooertv Address 304 West Main Street
City Mechanicsburp County Cumberland State PA Zin Code 17055-320 I
Lender N/ A
Sketch Not To Scale
~
N
Bedroom~ 8 Bedroom
Bath
o
~ .od,oom J
Bedroom
in
<Xi
co
Dining Room
Sketch b'fApllK IV'"
Comments:
Living Room
First Floor
31.4'
AREA CALCULATIONS SUMMARY LIVING AREA BREAKDOWN
Code Description Size Net Totals llnIakdown Subtotals
GLA1 Firat Fl.oor 2153.12 2153.12 First Floor
pIp Patio 72.00 72.00 31.4 x 68.5 2148.48
GAR Garage 613.67 613.67 0,5 x 0.1 x 68.5 4.64
TOTAL LIVABLE
(rounded)
2153
2 Calculations Total (rounded)
2153
Fonn SKT.BldSkl- 'TOTAL for Windows' appraisal software by a la mode, inc. -1-800-ALAMOOE
.
.
Subject Photos
II
Borrower/Client Michael Nailor (Executor)
Prooertv Address 304 West Main Street
Citv Mechanicsburp' Countv Cwnberland State P A lio Code 17055-3201
Lender N/ A
Subject Front
304 West Main Street
Subject Rear
Subject Street
Form PIC3x5.TR - "TOTAL for Windows' appraisal software by a la mode, inc. -l-BOO-ALAMOOE
:
DEFINITION OF MARKET VALUE: The most probable price which a property should bring in a competitive and open market under all conditions
requisite to a fair sale, the buyer and seller, each acting prudently, knowledgeably and assuming the price is not affected by undue stimulus. Implicit in this
definition is the consummation of a sale as of a specified date and the passing of title from seller to buyer under conditions whereby: (1) buyer and seller are
typically motivated; (2) both parties are well informed or well advised, and each acting in what he considers his own best interest; (3) a reasonable time is allowed
for exposure in the open market: (4) payment is made in terms of cash in U.S. doHars or in terms of financial arrangements comparable thereto; and (5) the price
represents the normal consideration for the property sold unaffected by special or creative financing or sales concessions' granted by anyone associated with
the sale.
* Adjustments to the comparables must be made for special or creative financing or sales concessions. No adjustments are necessary
for those costs which are normally paid by sellers as a result of tradition or law in a market area; these costs are readily identifiable
since the seller pays these costs in virtually all sales transactions. Special or creative financing adjustments can be made to the
comparable property by comparisons to financing terms offered by a third party institutional lender that is not already involved in the
property or transaction. Any adjustment should not be calculated on a mechanical dollar for dollar cost of the financing or concession
but the dollar amount of any adjustment should approximate the market's reaction to the financing or concessions based on the
appraiser's judgement.
STATEMENT OF LIMITING CONDITIONS AND APPRAISER'S CERTIFICATION
CONTINGENT AND LIMITING CONDITIONS: The appraiser's certification that appears in the appraisal report is subject to the following
conditions:
1. The appraiser will not be responsible for matters of a legal nature that affect either the property being appraised or the title to it. The appraiser assumes that
the title is good and marketable and, therefore, will not render any opinions about the tille. The property is appraised on the basis of it being under responsible
ownership.
2. The appraiser has provided a sketch in the appraisal report to show approximate dimensions of the improvements and the sketch is included only to assist
the reader of the report in visualizing the property and understanding the appraiser's determination of its size.
3. The appraiser has examined the available flood maps that are provided by the Federal Emergency Management Agency (or other data sources) and has noted
in the appraisal report whether the subject site is located in an identified Special Rood Hazard Area. Because the appraiser is not a surveyor, he or she makes
no guarantees, express or implied, regarding this determination.
4. The appraiser will not give testimony or appear in court because he or she made an appraisal of the property in question, unless specific arrangements to do
so have been made beforehand.
5. The appraiser has estimated the value of the land in the cost approach at its highest and best use and the improvements at their contributory value. These
separate valuations of the iand and improvements must not be used in conjunction with any other appraisal and are invalid if they are so used.
6. The appraiser has noted in the appraisal report any adverse conditions (such as, needed repairs, depreciation, the presence of hazardous wastes, toxic
substances, etc.) observed during the inspection of the subject properly or that he or she became aware of during the normal research involved in performing
the appraisal. Unless otherwise stated in the appraisal report, the appraiser has no knowledge of any hidden or unapparent conditions of the properly or
adverse environmental conditions (inciuding the presence of hazardous wastes, toxic substances, etc.) that would make the property more or less valuable, and
has assumed that there are no such conditions and makes no guarantees or warranties, express or impiied, regarding the condition of the properly. The
appraiser win not be responsible for any such conditions that do exist or for any engineering or testing that might be required to discover whether such
conditions exist. Because the appraiser is not an expert in the field of environmental hazards, the appraisal report must not be considered as an
environmental assessment of the properly.
7. The appraiser obtained the information, estimates, and opinions that were expressed in the appraisal report from sources that he or she considers to be
reliable and believes them to be true and correct. The appraiser does not assume responsibility for the accuracy of such items that were fumished by other
parties.
8. The appraiser will not disclose the contents of the appraisal report except as provided for in the Uniform Standards of Professional Appraisal Practice.
9. The appraiser has based his or her appraisal report and valuation conclusion for an appraisal that is subject to satisfactory completion, repairs, or
alterations on the assumption that completion of the improvements will be performed in a workmanlike manner.
10. The appraiser must provide his or her prior written consent before the lender/client specified in the appraisal report can distribute the appraisal report
~ncluding conclusions about the property value, the appraiser's identity and professional designations, and references to any professional appraisal
organizations or the firm with which the appraiser is associated) to anyone other than the borrower; the mortgagee or its successors and assigns; the mortgage
insurer; consuttants; professional appraisal organizations; any state or federaily approved financial institution; or any department, agency, or instrumentality
of the United States or any state or the District of Columbia; except that the lender/client may distribute the property description section of the report only to data
coUection or reporting service(s) without having to obtain the appraiser's prior written consent. The appraiser's written consent and approval must also
be obtained before the appraisal can be conveyed by anyone to the public through advertising, public relations, news, sales, or other media.
Freddie Mac Form 439 6-93
Page 1 of 2
Fannie Mae Form 1004B 6-93
Forrester & Co. Real Estate Appraisers
Form ACR - 'TOTAL for Windows' appraisal software by a la mode, inc. - 1-800-ALAMODE
II
II
.
,
APPRAISER'S CERTIFICATION: The Appraiser certifies and agrees that
1. I have researched the subject market area and have selected a minimum of three recent sales of properties most similar and proximate to the subject property
for consideration in the sales comparison analysis and have made a dollar adjustment when appropriate to re/lect the market reaction to those items of signnicant
variation. If a signnicant item in a comparabie property is superior to. or more favorable than, the subject property. I have made a negative adjustment to reduce
the adjusted sales price of the comparable and. if a significant item in a comparable property is inferior to, or less favorable then the subject property. I have made
a positive adjustment to increase the adjusted sales price of the comparable.
2. I have taken into consideration the factors that have an impact on value in my development of the estimate of market value in the appraisal report. I have not
knowingly withheld any Significant information from the appraisal report and I believe, to the best of my knowledge. that all statements and information in the
appraisal report are true and correct.
3. I stated in the appraisal report only my own personal. unbiased. and professional analysis. opinions. and conclusions. which are subject oniy to the contingent
and iimiting conditions specified in this form.
4. I have no present or prospective interest in the property that is the subject to this report. and I have no present or prospective personal interest or bias with
respect to the participants in the transaction. f did not base. either partially or completely, my analysis and/or the estimate of market value in the appraisal report
on the race. color. religion. sex. handicap. familial status. or national origin of either the prospective owners or occupants of the subject property or of the present
owners or occupants of the properties in the vicinity of the subject property.
5. I have no present or contemplated future interest in the subject property, and neither my current or future employment nor my compensation for performing this
appraisal is contingent on the appraised value of the property.
6. I was not required to report a predetermined value or direction in value that favors the cause of the client or any related party, the amount of the value estimate.
the attainment of a specific result, or the occurrence of a subsequent event in order to receive my compensation and/or employment for performing the appraisal I
did not base the appraisal report on a requested minimum valuation, a specific valuation. or the need to approve a specific mortgage ioan.
7. I performed this appraisal in conformity with the Uniform Standards of Professional Appraisal Practice that were adopted and promulgated by the Appraisal
Standards Board of The Appraisal Foundation and that were in place as of the effective date of this appraisal. with the exception of the departure provision of those
Standards, which does not apply. I acknowledge that an estimate of a reasonable time for exposure in the open market is a condition in the definition of market value
and the estimate I deveioped is consistent with the marketing time noted in the neighborhood section of this report, unless I have otherwise stated in the
reconciliation section.
8. I have personally inspected the interior and exterior areas of the subject property and the exterior of all properties listed as comparables in the appraisal report.
I further certify that I have noted any apparent or known adverse conditions in the subject improvements, an the subject site, or on any site within the immediate
vicinity of the subject property of which I am aware and have made adjustments for these adverse conditions in my analysis of the property value to the extent that
I had market evidence to support them. I have also commented about the effect of the adverse conditions on the marketability of the subject property.
9. I personally prepared all conclusions and opinions about the real estate that were set forth in the appraisal report, If I relied on significant professional
assistance from any individual or individuals in the performance of the appraisal or the preparation of the appraisal report, I have named such individual(s) and
disclosed the specific tasks performed by them in the reconciiiation section of this appraisai report. I certify that any individual so named is qualified to perform
the tasks. I have not authorized anyone to make a change to any item in the report; therefore, n an unauthorized change is made to the appraisal report, I will take
no responsibility for it.
10. This appraisal report is prepared for the sole and exclusive use of Michael Nailor (Executor), the client, to determine the retrospective market value
as of the date of death of Mrs. Sara L. Nailor on December 20,2004; for estate tax purposes. No third parties are authorized to rely upon this report
without the express written consent of the appraiser. The appraiser is not a home u..pector. This report should oot be relied upon to disclose any
conditions present in the subject property. The appraisal report does oot guarantee that the property is free of defects.
SUPERVISORY APPRAISER'S CERTIFICATION: If a supervisory appraiser signed the appraisal report, he or she certifies and agrees that:
I directly supervise the appraiser who prepared the appraisal report, have reviewed the appraisal report, agree with the statements and conclusions of the appraiser.
agree to be bound by the appraiser's certifications numbered 4 through 7 above, and am taking full responsibility far the appraisal and the appraisal report.
ADDRESS OF PROPERTY APPRAISED: 304 West Main Street, Mechanicsburg, PA 17055-3201
APPRAISER:
Signatur~ '*
Name: '. ~ ~iRI,~ppraiser
Date Signed: March 31. 005
State Certification #: GA-OO 1580-L
or State License #:
State: P A
Expiration Date of Certification or License: 06/30/2005
SUPERVISORY APPRAISER (only if required):
Signature:
Name:
Date Signed:
State Certification #:
or State License #:
State:
Expiration Date of Certification or License:
~Did
o Did Not Inspect Property
Freddie Mac Form 439 6-93
Page 2 of 2
Fannie Mae Form 10048 6-93
Form ACR - 'TOTAL far Windows' appraisal software by a la made, inc. - 1-800-ALAMODE
Comparable Photo Page
II
Borrower/Client Michael Nailor (Executor)
ProDertv Address 304 West Main Street
Citv Mechanicsbur" Counlv Cumberland Stale P A Zin Code 17055-3201
Lender N I A
Comparable 1
3 York Circle
Comparable 2
3468 Trindle Road
Comparable 3
38 Oakwood Avenue
Form PIC3x5.BC - 'TOTAL for Windows' appraisal software by a Ia mode, inc. - 1-800-ALAMOOE
, I
..
Comparable Photo Page
Borrower/Client Michael Nailor /Executor)
Pronertv Address 304 West Main Street
Citv Mechanicsburll' Countv Cumberland State P A lin Code 17055-3201
Lender N/A
Comparable 4
511 Cocklin Street
fonn PfC3x5.BC - 'TOTAL tor Windows' appraisal software by a la mode, inc. -1-800-ALAMODE
II
Borrower/Client Michael Nailor (Executor)
ProDertv Address 304 West Main Street
Citv Mechanicsburl! Countv Cumberland State PA liD Code 17055-3201
Lender N/ A
Comparable Sales Map
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II
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Site Map
Borrower/Client Michael Nailor (Executor)
PrODertv Address 304 West Main Street
City Mechanicsburl! Countv Cumberland State PA Zi Code 17055-3201
Lender N/ A
Title: 304 West Main Street, Mechmicsburg
Dc.e: 03-28-2005
Sctle: 1 inch = 21 met
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Form MAP.Site - "TOTAL for Windows" appraisal software by a la mode, inc. - 1-800-ALAMODE
Deed
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Pronertv Address 304 West Main Street PA lio Code 17055-3201
Citv Mechanicsburl! Countv Cumberland Slale
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Form MAP.Generic - 'TOTAL for Windows' appraisal software by a la mode, inc. -1-800.ALAMOOE
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Tax Assessor's Map
Borrower/Client Michael Nailor CExecutoi'\
Prooertv Address 304 West Main Street
CiiV Mechanicsbur<> Countv Cumberland State PA Zin Code 17055-3201
Lender N/A
f .'
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Form MAP.Tax - "TOTAL for Windows' appraisal software by a la mode, inc. - 1-800-ALAMOOE
II
Page 1 of 1
Lindey Vial - Fwd: Louise Shelley Estate Checkbook of Estate Account
,~~~c~~~{:~~jEn~;'~~~~~~~~~~'F.ln.'~ln7
From:
To:
Date:
Subject:
Allen Haar
Lindey Vial
8/8/2005 1:34:25 PM
Fwd: Louise Shelley Estate Checkbook of Estate Account
Hi Allen,
The attached Excel file is a little more complicated than needed but I am just learning to do reports from the
Microsoft Money program. Sorry!
The $6038 in "misc. income" that was listed on the overall spreadsheet that I gave you comes from:
984.00 from PPL Dividend
1629.26 from Ruth Michael Trust
106.25 from Janney Montgomery account dividends
66.24 from Janney Montgomery account dividends
57.25 from Patriot News refund of subscription
3195.00 from Theodore Shelley Trust
The only detail that is hanging fire is the letter regarding date of death values on the American Investors
annuities. I will try to follow up on that on Monday.
f think this concludes the items that you need from me. Of course, if there is anything else, please don't hesitate
to email or call.
Michael
file://C: \Documents %20and% 20Settings\Administrator\Local %20Settings\ Temp\GW } 0000 ... 8/8/2005
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FROM:
Forrester & Co. Real Estate Appraisers
359 East Market Street
York, PA. 17403
(717) 812-1118
INVOICE DATE REFERENCE
05-139 03/28/05 Nailor
Tax I.D.# 23-3063271
FOR PROFESSIONAL APPRAISAL SERVICES
RENDERED.
TO:
Michael Nailor
651 Fifth Street
Northumberland, P A 17857
DESCRI PTION AMOUNT
304 West Main Street 300.00
Mechanicsburg Borough, Cumberland County
Mechanicsburg, PA 17050-3201
Owner: Nailor, Stanley G. & Sara L. (Deceased)
Paid $300 3/28/05 Ck. #997 -300.00
,
Thank .vou for vour business!
,
Subtotal :$
,
late Fee :$
TOTAL $ ,
Payment is due within 30 days of invoice date.
A service charge of2% per month will be applied if account is more than 30 dayS past due.
Forrester & Co. Real Estate Appraisers
Form NIN - "TOTAL for Windows" appraisal software by a la mode, inc. - 1-800-ALAMODE
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I
ESTATE VALUATION
ELIJAH WATSON 6/20/05
NANCY KLAHOLD
Date of Death: 12/10/2004
Valuation Date: 12/10/2004
Processing Date: 06120/2005
Shares
Or Par
Secun ty
Description
II
Esta te of: LOUISE SHELLEY
~~B6i:iurit"dbobdI51989795Q I
Rep~ortType:Date of Deatn '
Number of Securities: 12
File ID: EVI_20050620_1519897950
Low /Bid
Mean and/or Div and Int Security
Adjustments Accruals Value
High/ASk
I)
5017.73 WACHOVIA PT MONEY MARKET (997981006)
2) 25000 MONTROSE PA AREA SCH DIST G.O. BDS (615202BP2)
Financial Times Interactive Data
DTD: 09/01/2001 Mat: 01/01/2009 4.05%
12/10/2004 102.44000 Mkt
Int: 07/01/2004 to 12/10/2004
3) 25000 NORTHWEST AREA SCH DIST PA LUZ G.O. BDS (667324DS3)
Financial Times Interactive Data
DTD: 09/15/2001 Mat: 04/01/2008 3.8%
12/10/2004 102.79900 Mkt
Int: 10/01/2004 to 12/10/2004
4) 25000 OXFORD PA AREA SCH DIST REF BDS (691789EZO)
Financial Times Interactive Data
DTD: 12/15/2001 Mat: 02/15/2007 4%
12/10/2004 103.67800 Mkt
Int: 08/15/2004 to 12/10/2004
5) 25000 RIDLEY PA SCH DIST G.O. BDS (766357DFl)
Financial Times Interactive Data
DTD: 12/15/2001 Mat: 11/15/2006 3.5%
12/10/2004 102.65100 Mkt
Int: 11/15/2004 to 12/10/2004
6) 25000 WHITEHALL TWP PA G.O. NOTE (965203GM8)
Financial Times Interactive Data
DTD: 08/15/2001 Mat: 08/01/2010 4.25%
12/10/2004 102.98000 Mkt
Int: 08/01/2004 to 12/10/2004
7) 25000 WILLISTOWN TWP PA G.O. BDS (970809BVO)
Financial Times Interactive Data
DTD: 09/15/2001 Mat: 12/15/2010 4.2%
12/10/2004 103.43500 Mkt
Int: 06/15/2004 to 12/10/2004
8) 25000 YORK PA CITY SCH DIST G.O. BDS (986846NB5)
Financial Times Interactive Data
DTD: 11/15/2001 Mat: 02/15/2006 3.15%
12/10/2004 101.31500 Mkt
Int: 08/15/2004 to 12/10/2004
11673.152 EVERGREEN MUN TR (300258506)
SHRT INTR MUN
12/10/2004
9}
10.11000
Accrual
10)
28690.994 EVERGREEN PA TAX fREE FD (300326402)
CL Y
12/10/2004
11. 53000
Accrual
11) 169.885277 DODGE & COX STK FD (256219106)
COM
Mutual fund (as quoted by NASDAQ)
12/10/2004
129.84000 Mkt
Page 1
5,017.73
25,610.00
25,699.75
25,919.50
25,662.75
25,745.00
25,858.75
25,328.75
118,015.5a
330,807.16
22,057.90
This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions,
please contact EVP Systems at (8181 313-6300 Or www.evpsys.com. (Revision 7.0.4)
102.440000
447.19
102.799000
182.08
103.678000
319.44
102.651000
60.76
102.980000
380.73
103.435000
510.42
101.315000
251.56
10.110000
100.71
11. 530000
433.38
129.840000
Date of Death: 12/10/2004
Valuation Date: 12/10/2004
Processing Date: 06/20/2005
Estate of: LOUISE SHELLEY
Account: 000001519897950
Report Type: Date of Death
Number of Securities: 12
File ID: EVI 20050620 1519897950
- -
Shares
or Par
Security
Description
High/ASk
Low/Bid
Mean and/or Div and Int Security
Adjustments Accruals Value
12 )
661.98487 EVERGREEN TR (299909408)
STRATEG GRW I
Mutual Fund (as quoted by NASDAQ)
12/10/2004
25.73000 Mkt
25.730000
17,032.87
Total Value:
Total Accrual:
Total: $675,442.00
S672, 755.73
$2,686.27
Page 2
This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions,
please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.0.4)
Pennsylvania State Employees Credit Union
1I1111111
II
P.O. Box 67013 (717) 234-8484 (Harrisburg)
Harrisburg, PA 17106-7013 (800) 237-7328 (Nationwide)
website - http://www.psecu.com
IMPORTANT
TAX RETURN DOCUMENT
ENCLOSED
1...111...111....1.1..1.1...11...1.111.....11111....1..1..1.11
LOUISE SHELLEY
304 W MAIN 5T
MECHANICSBURG PA 17055-3201
JOINT OI\INER
PAGE 1
'PSE(~
Account 0183XYYYXX SHELLEY, LOUISE
Document Number: 2048069
Effect: 12/21/04 Post: 12/21/04 Tlr: 0181
ID DUE DATE
PRINCIPAL INTEREST
FEES
NEW BALANCE TRAN AMOUNT
SEQ
------------------------------------------------------------------------------
Withdrawal from REGULAR SHARES
01 123,245.40- 0.00
0.00
Prev Bal:
0.00
123,245.40
123,245.40 #269202
------------------------------------------------------------------------------
Check Disbursed
ESTATE OF LOUISE SHELLEY
123,245.40-
.'1
LOUISE SHELLEY
304 W MAIN ST
MECHANICSBURG PA 17055-3201
12-20-2004
11:14:06
:~~~ouli;tnJ}m9~;r: 990000 7JF74. .~I'f):()
Short name: SHELLEY S LOUISE
Type: CERTIF OF DEPOSIT
*------------Balance Data-----------*
Current balance: 102,748.64
Hold amount:
Available Balance:
Interest due:
*--------Basic Interest
Interest rate:
Average rate:
Daily factor:
Int paid YTD:
Interest W/H YTD:
Interest method:
*-----------Account
Issue/Open date:
Last renewed:
Maturity date:
Automatically renewable:
Avail interest:
F3=Exit F13=Inquiry wi
Wlt"-; PI) N r
Time Inqu~ry
Basic Account Data
, I
Next Display: , ,2,
*------------Customer
S LOUISE SHELLEY
304 W MAIN ST
MECHANICSBURG PA 17055
30-0700-1
DSPBR01820
Data-------------*
102,748.647 102/33511
86.47 Home phone:
Data--------* Business phone:
1.540 Officer: 233 TIN/Crt: 183-12-2724 C
1.540 *------------Payment Data--------------*
4.323303 Next payment date: 12-31-04
1,437.24 Payment amount: 134.02
.00 Disposition: (CAPITALIZE)
SIM LE INT Last payment date: 11-30-04
Dates-----------* Last payment amount: 129.53
2-25-03 Last payment APY earned: 1.55
2-25-03 *---------------Comments---------------*
2-25-05
YES
2,748.64
dow F15=Restart
717-766-4564
\ *37/2.-4.-
X ZO!3CJ5
7'3.1S ouxuecl,nrerc3
WA'-1 Po /AI r
Checking Account Inquiry Next
Basic Account Data
*---------Account
S LOUISE SHELLEY
304 W MAIN ST
MECHANICSBURG PA
1~.!20-2004
11:32:25
~p:gql1tl tIlumber : 200309 8IlBA'
Short name: SHELLEY S LOUISE
TIN: 183-12-2724 TIN Crt: C BR: 49
*-----------Balance Data------------*
Current balance: 40,546.37
Avail balance: 40,546.37
Avail tomorrow: 40,546.37
Memo balance: -G; C' 546.370
Hold amount: ~~
Check CR balance: 0' .00
Interest due:~' 27.78
In~ pd this year: 245.23
Int pd last year: 268.25
Acct current rate: 1.26000
*-----------Account Data-- ---------*
Stat: 5 Pro type: 100
Statement code/cycle: C / 31
Date opened: 7-18-96
Processed thru: 12-19-04
F3=Exit FIO=Acct inqui y charge
display: ,0,2, 20-0700-1
DSPBR01820
Name/Address----------*
17055
*----------Customer Activity------------*
Stops/holds active:
Date last contact:
Date last active:
Date last deposit:
Amount last deposit:
*-------Previous Statement
Last stmt date:
Last stmt balance:
Checks/deposits since:
Service charge type/plan:
Combined stmt/nbr copies:
F13=Inquiry window F15=Restart
7-18-96
10-31-00
7-18-96
.00
Data---------*
4-30-04
40,370.14
0/0
R 8
N 0
2LtS23
"'2D/3f.1S
I, 62 O-CU'vlul <\ (\-teresr
"
,("-"i
~...../
I ~~ bT~~ E:;
1-800-773-7373
CaU Citizens' PhoneBank anytime for account information,
current rates and answe~ to your questions.
USQ59 BR292
S LOUISE SHELLEY
304 W MAIN ST
MECHANICSBURG PA
6
1
17055-3201
Citizens Circle GoLd
Account Statement
8 OF 3
Beginning November 17, 2004
through December 15, 2004
Contents
Summary Page 1
Checking Page 2
Savings Page 3
Citizens Circle GoLd Summary
Account
Account Number
Balance
Last Statement
Balance
This Statement
DEPOSIT BALANCE
Checking
Savings
Monthly combined balance to waive monthly fee is
Your monthly combined balance this statement period is
20,000.00
28,913.63
\, ~2,
~G.tJl
10.03
}l.2D lolls
. 55 ~CCf\..A.Lclj (1\e(e st
~'l~rllber FD{C 8- [quai. Housing l.~mier
';~e '<:''1er''e <;id,; Fvf il1lpolt(~nt infr)J!Tliltio:l
S LOUISE SHELLEY
Circle Gold Checking w/Interest
610070-635-4
e
e
Total Deposit Balance
26,783.20
Total Relationship Balance
26.783.20
..
1-800-773-7373
Call Citizens' PhoneBank anytime for account Information,
current rates and answel5 to your questions.
Checking
SUMMAIlY
Balance Calculation
Previous Balance
Checks
Withdrawals
Deposits & Additions
Interest Paid
Current Balance
9,090.28
7,769.90 -
69.35 -
3,181.51 +
1.42 +
4,433.96 =
Bolonce
Average Daily Balance
7,147.01
Account Statement
o OF 3
Beginning November 17, 2004
through December 15, 2004
S LOUISE SHELLEY
Circle Gold Checking w/lnterest
610070-635-4
Previous Balance
TRANSACTION DETAILS
Checks. There is a break in check sequence
Check' Amount Date
846 1,500.00 11/.18
847 100.00 11Z17
848 69.90 11/22
Interest
Current Interest Rate
Annual Percentage Yield Earned
Number of Days Interest Earned
Interest Earned
Interest Paid this Year
.25%
.25%
29
1.42
22.54
Check'
849
850
851
Amount
1,500.00
600.00
4,000.00
Date
12/.07
12Z06
12/07
Withdrawals
Other Withdrawals
Date Amount Description /
11/22 16.04 Pp Hec Bill 041122 4102079009ws ./
11/23 42.23 Comcast Central Central PA 11230422919901
11/30 11.08 United Water Pen Water Bill 041129999550140 ..I
Deposits & Additions
Date Amount
11/29 162.92
12/01 1,208.05
12/01 1,160.00
12/01 400.00
12/01 1~5.54
12/06 105.00
Description
Deposit ./
US Treasury 312 Civil Serv 120104 F Ij82865 W Csf V
Bur Of Pub Debt H/Hh Intst 120104
Bur Of Pub Debt H/Hh Intst 120104
I"ellon Common Pens Pmts 120104 ./
Deposit ../
Interest
Date
12/15
Amount Description
1.42 Interest
iJ~~
Daily Balance
Date Balance Date Balance Date Balance
11/17 8,990.28 11/29 7,525.03 12/06 9,932.54
11/18 7,490.28 11/30 7,513.95 12/07 4,432.54
11/22 7,404.34 12/01 10,427.54 12/15 4,433.96
11/23 7,362.11
i'1en~t:er nw,: t=.}' i:411,~1 rlOlls~r:~ '.,~iid~l
~\'.,' (p'li'r~,~ ~ll.i~ [\)1 ;nliWl'r,::;~~ i!d'Jr:;,?ii~;I\
9,090.28
o
Total Checks
7,769.90
o
Total Withdrawals
69.35
o
Total Delloslts & Additions
3,181.51
o
o
Total Interest Paid
1.42
Current Balance
~
~
1 Il~.E~
1-800-773-7373
-0 A .~~T
;~j IJlr" 1 ~
CaU Citizens' PhoneBank anytime for account infonnation.
current rates and answers to your questions.
Savings
SUMMARY
Balance Calculation
Previous Balance
Withdrawals
Deposits & Additions
Interest Paid
Current Balance
21,036.63
.00 -
1,304.00 +
8.61 +
22,349.24 =
Balance
Average Daily Balance
21,670.60
Interest
Current Interest Rate
Annual Percentage Yield Earned
Number of Days Interest Earned
Interest Earned
Interest Paid this Year
.50M,
.50Y0
29
8.59
141.53
TRANSACTION DETAILS
Deposits & Additions
Date Amount Description
12/02 1,304.00 US Treasury 303 SOC Sec 120304
Interest
Date
11/30
Amount Description
8.61 Interest
Daily Balance
Date
11/30
Balance
21,045.24
Memhe:r FDIC {~). ::qu;;l Ho:.!sing Lendel
~,('e reverse side l'ar iIlHw,t::Hlt illformntion
Date
12/02
Balance
22,349.24
Balance
Date
Account Statement
o OF 3
Beginning November 17, 2004
through December 15, 2004
S LOUISE SHELLEY
Tiered Rate Savings
6140-204879
Previous Balance
21,036.63
o
Total Deposits & Additions
1,304.00
o
o
Total Interest Paid
8.61
Current Balance
22,349.24
1 ACCoUNT NAME: THEODORE SHELLEY T / A NIMCRT 1519898423
6390
TRUST 1.0. NUMBER: 25 - 6771249
WACHOVIA BANK, N. A.
CHARITABLE SERVICES, NC6732
100 NORTH MAIN STREET, 13TH FLOOR
WINSTON-SALEM, NC 27150
TAX INFORMATION LETTER
BENEFICIARY:
ESTATE OF S. LOUISE SHELLEY
W. MICHAEL NAILOR
651 FIFTH STREET
NORTHUMBERLAND, PA 17857
1.0. NUMBER: 111-11-1111
#
TAX YEAR
BEGINNING 01/01/2004
ENDING 12/31/2004
ENTER THE AMOUNTS LISTED BELOW ON YOUR U.S. INCOME TAX RETURN
I N COM E
u.S. GOVERNMENT INTEREST REPORTED AS DIVIDENDS:
TOTAL FOR YEAR ............................................... 175 .
(ENTER THE ABOVE ON FOiM 1040, LINE 9A)
8.
OTHER INTEREST INCOME ...........................................
(ENTER THE ABOVE ON FORM 1040, LINE 8A)
DIVIDEND INCOME:
QUALIFIED .................................................... 736 .
(ENTER THE ABOVE ON FORM 1040, LINE 9B)
2,140.
TOTAL FOR YEAR ...............................................
(ENTER THE ABOVE ON FORM 1040, LINE 9A)
. .............. ....... ...........
2,323.
2,323.
INCOME FOR MINIMUM TAX PURPOSES
INCOME FOR REGULAR TAX PURPOSES
... ... .... ..... ........... ... ....
S TAT E
I N COM E
T A X
I N FOR MAT ION
-------------------------------------------------------
FOR PENNSYLVANIA STATE INCOME TAX PURPOSES:
NET T.AXA.BLE INCOME ...........................................
2,945.
-
Report the amounts listed above on your 20 04 tax return. These may differ from payments actually received by you. The
difference may be caused by the exclusion of tax-exempt income, our agreed plan of remitting, fiduciary deduction, or variance
between your taxable year and that of this account. If you have interests in other accounts, appropriate schedules will follow.
vn7'lA ":I nnn ____ __ __ _ - ------ ----- - ---
.......^"''''''''.........
"\
.,
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For BPD or FRB use only:
Customer Name
Customer No.
PO F 4000 E
Department of the Treasury
Bureau of the Public Debt
(Revised June 2000)
REQUEST TO REISSUE UNITED STATES SAVINGS BONDS
(ADD BENEFICIARY OR COOWNER, REMOVE BENEFICIARY OR DECEDENT, SHOW CHANGE OF
NAME, AND/OR CORRECT ERROR IN REGISTRATION)
OMS No. 1535-0023
IMPORTANT: Follow instructions in filling out this form. You should be aware that the making of any false, fictitious or fraudulent claim or statement
to the United States is a crime punishable by imprisonment of not more than five years or a fine up to $250,000, or both, under 18 U.S.C. ~287,
18 U.S.C. ~1001, and 18 U.S.C. ~3571. Additionally, 31 U.S.C. ~3729 provides for civil penalties for the maker of a false or fraudulent claim to the
United States of an amount not less than $5,000 and not more than $10,000, plus treble the amount of the Government's damages as an additional
sanction.
PRINT IN INK OR TYPE ALL INFORMATION
1.
I request reissue of the bonds described below, in the amount of $
97 lYl/O
J
(total face amount).
REGISTRATION
ISSUE DATE FACE AMOUNT BOND NUMBER (Social security number and names,
including middle names or initials, on the bonds)
t/ LJ-/1r ~ .51? tJ I't, rfA'1;;1'"~t6z.7Yrl'" '" ,'; Iff 3 12 Z72'/
",,' ."<:"2~,~'s'.;;'i;;j.>.<.<../1::I1+ ; - -
tJ1 Iff 5'" ~/JtJ t1'tJ .~t6'j,t?;l.e.;,?5'iHi-I .;5 L tNt r5~ SHELL #y
- .......-
tJ 2/ / tif:s- / Piltl e-'(J ''!(j:3.tJ.#.g{j-6tJ,.fll-I- t/f2--:.
-' .......... ........-:-
}It! /11 / CHI1&L /1/11 / LtJ(?-
tJ 1/ .- j 91 5 /0 PI? t:p :IJ;Z~~q. ~f4.~il iff-(
r:J/f ;-/f/j~ /0 P/l ty~ 'tJJ..$aap'l'b.2--f/-1d
(If you ,(eed more space to describe your bonds, use page 4.)
2. Reissue is requested to: (Check all that apply.)
a. DAdd a coowner or beneficiary
b. DChange present beneficiary to coowner.
c. D Remove the name of a living beneficiary and issue the bonds in either single ownership form or with another person as
coowner or beneficiary. (For Series E or H bonds, the present beneficiary must sign.)
d. (i1"Remove the name of a deceased registrant and issue the bonds in either single ownership form or with another person
as coowner or beneficiary. (For Series E or H bonds, furnish proof of death. For Series EE or HH bonds, furnish proof of
death of owner or coowner.)
e. DShow change of name by: D marriage D divorce D court order D naturalization Dother
Explain
f. D Correct error in registration.
(1) Who purchased the bonds?
(2) Whose funds were used?
(3) How did the error occur?
3. Registration for new bonds: /~4 - -.:Ji - 3LfS-7
(Social Security Number)
kI. /J1IC~L- /VA-I Lo;2-
(First Name. Middle Name or Initial, Last Name)
b,5"'/ Fi F7(imberan~~f~'ute)
A0/!rlll/t11t5~~L/f!JO;1J- /7?57
To name a coowner or beneficiary, (City) (State) (ZIP Code)
complete the following:
[]coowner }
[] beneficiary (POD)
(First Name, Middle Name or Initial, Last Name)
4. Delivery instructions, if
different from above:
(Name)
(Number and Street or Rural Route)
(City)
(State)
(ZIP Code)
(1 )
r' ,
DESCRIBE ADDITIONAL BONDS BELOW
REGISTRATION
ISSUE DATE FACE AMOUNT BOND NUMBER (Social security number and names,
Including middle names or initials, on the bonds)
C '-I --191 g- /O(J~ ,,11' :t!2!1i?dZ-iJ~gl-lff
.---
tJLf Iff S'- Ipt:'fl ". '7/1.J'fPtlzlllf11fl
,
-/ff~ ;1 m,~{(,~~.{/#gtl.ll /13 - I 2 - 2 72- 'I
t1 L/ / /llJ cJ
tJtj ,-I C;9~ Ilfl If 'ill/i/Ap."j.lllf;' illI 5 LeJl-t /5" E SJ-fEI- LGY
~ 'I- I 91:;- /tJlJtJ /# 1lt:;ftit? 2'167411 cJ/~
"
I (l Pfl t;J! 21/Pff/1I -- AJ /IlL t!J /L
rJlf r 19tj~ 1fIfigiJIJ W. ;JIIC/-f/l-EL
I
i:.~ 1 I f' {5- I t?t1 t1 ~() l!?&eO ;?I/t 7 11#
.-
t1 f' IttfyS-- /tJ tJ jJ plf /pjf'f)// 2J.f 7//1/1/
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t/ '1 Iff ~ /tltltfl t'~ 4/fZltJ-lL/7/ IJ Ii
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1775'" 1t7t?~ Pt:> /J?#ptP ~1173f! H
/l -
I?- -j ffs- /t7t7tl t7.P ttl;j(Cd124>.//7~JI#
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I~ -/ff~ /tJtJt? lj A1~tJ~1j75r11-1
tJ r- Iff, /JCJ tJtJ t;.P V75'"~2 l#Z' H-H
/2- - I fiLls- 5"bt?tJ tip /;!J5:~2.lllI Ifi-I
/2- /'115 IIJ~~ ('f! X1tJ'i.j~ ..,~s- tff-f!
~
1;2 / 71 f;-- /~ l'iPt7 ~p X"lt/J'jd/f f./-I 1'1
-
/7 -/ 11,;;-- 1tJ. /l/l~ t1.J? '~7g:;fYo'l.l/1t1
17 / 9 f':)' /(), PtJO '.1 x~f;:f3j(j'lr.llf.l
,-
/2- 19'15"" /~lJtJo H ~1:7ttfiC~ tftflff/
-- ." ',f., ,,' Zl'J, . <.... '
NOTICE UNDER THE PRIVACY AND PAPERWORK REDUCTION ACTS
The collection of the information you are requested to provide on this form is authorized by 31 U.S.C. Ch. 31 relating to the public debt of the United States. The
furnishing of a social security number, if requested, is also required by Section 6109 of the Internal Revenue Code (26 U.S.C. ~61 09).
The purpose for requesting the information is to enable the Bureau of the Public Debt and its agents to issue securities, process transactions, make payments, identify
owners and their accounts, and provide reports to the Internal Revenue Service. Furnishing the information is voluntary; however, without the information Public
Debt may be unable to process transactions.
Information concerning securities holdings and transactions is considered confidential under Treasury regulations (31 CFR, Part 323) and the Privacy Act
(5 USC ~552a). this information may be disclosed to a law enforcement agency for investigation purposes; courts and counsel for litigation purposes; others
entitled to distribution or payment; agents and contractors to administer the public debt; agencies or entities for debt collection or to obtain current addJ1esses for
payment; agencies through approved computer matches; Congressional offices in response to an inquiry by the individual to whom the record pertains; 'as otherwise
authorized by law or regulation.
We estimate it will take you about 30 minutes to complete this form. However, you are not required to provide infornuition requested unless a valid OMB control
number is displayed on the form. Any comments or suggestions regarding this form should be sent to the Bureau of the Public Debt, Forms Management Officer,
Parkersburg, WV 26106-1328. DO NOT SEND completed form to the above address; send to the correct address shown in the instructions.
(4)
~
DESCRIBE ADDITIONAL BONDS BELOW
REGISTRATION
ISSUE DATE FACE AMOUNT BOND NUMBER (Social security number and names,
including middle names or initials, on the bonds)
I;;. -/975" ~ tft7/l p :Y//li~9:I)flJI
./
j;t - /f/i,5 ~ /J(.J t' .t'~ )'1t?cf#d51 f/fI
It,J-/2-27:ZY
s: LIY t//~,F :5f;c-Z-LFy
~ !4/. $/clf/7&L- A/,4/I~~ -
p
NOTICE UNDER THE PRIVACY AND PAPERWORK REDUCTION ACTS
The collection of the information you are requested to provide on this form is authorized by 31 U.s.C. Ch. 31 relating to the public debt of the United States. The
furnishing of a social security number, if requested, is also required by Section 6109 ofthe Internal Revenue Code (26 U.S.C. 96109).
The purpose for requesting the information is to enable the Bureau of the Public Debt and its agents to issue securities, process transactions, make payments, identify
owners and their accounts, and provide reports to tbe Internal Revenue Service. Furnishing the information is voluntary; however, without the information Public
Debt may be unable to process transactions.
Information concerning securities holdings and transactions is considered confidential under Treasury regulations (31 CFR, Part 323) and the Privacy Act
(5 use 9552a). This information may be disclosed to a law enforcement agency for investigation purposes; courts and counsel for litigation purposes; others
entitled to distribution or payment; agents and contractors to admimster the public debt; agencies or entities for debt collection or to obtain current addresses for
payment: agencies through approved computer matches: Congressional offices in response to an inquiry by the individual to whom the record pertains; as otherWIse
authorized by law or regulation.
We estimate it will take you about 30 minutes to complete this form. However, you are not required to provide information requested unless a valid OMB control
number is displayed on the form. Any comments or suggestions regarding this form should be sent to the Bureau of the Public Debt, Forms Management Officer.
Parkersburg. WV 26106-1328. DO NOT SEND completed form to the above address; send to the correct address shown in the instructions.
(4)
~
' 5. Under penalty of perjury, I certify the number shown on the form is my correct taxpayer identification number. If Seri~s HH/H bonds are
. . In""'_, 1 rertify thatt am not .ubjeot 10 bao,,"p w;thholdlng otthe, (i) be",U'. 1 ha,. not been notified that I am .ubJ." to ""okup
withholding (as a result of a failure to report all interest or dividends), or (ii) because I have been notified by the Internal Revenue Service
that I am no longer subject to backup withholding. (See Backup tax withholding in the instructions.)
Sign in ink in the presence of an authorized certifying officer.
(See Item 5in the instructionsfor who must sign.)
(Signature) (Signature)
ft/ lII/e/lnEt- /1111/ LtJt2-
(Print Name) . (Print Name)
65/ AFI/! S7k!E6T
(Number and Street or Rural Route) (Number and Street or Rural Route)
/t/rl,f7J1iI1116E/2- #fill:) ;Jr J 7tsJ
(City) (State) , (Zip) (City) (State) (Zip)
/b1---3F---3lf~7
(Social Security Number) (Social Security Number)
ll/r.?A/Cr~@ r/l)'lv'~r
(Email Address) (Email Address)
~7t?- 2-7/- 326/1 x~26t
(Daytime Telephone Number} (Daytime Telephone Number)
The certification portion must be completed. ..... .'
I CERTIFY that I CERTIFY that
whose identity is well-known or proved to me, personally whose identity is well-known or proved to me, personally
appeared before me this day of , appeared before me this day of ,
(Month) (Month)
, at , at .
(Year) (City) (State) (Year) (City) (State)
and signed this form. and signed this form.
(Signature of certifying officer) (Signature of certifying officer)
(OFFICIAL STAMP (OFFICIAL STAMP
OR SEAL) (Title of certifying officer) OR SEAL) (Title of certifying officer)
(Address) (Address)
Reserved for Identification Notations
Customer Account Number Customer Account Number
and Date Established: and Date Established:
Identified by: Identified by:
Documents - Descriptions: Documents - Descriptions:
(2)
..
ING ..IaJ
February 4,2005
Kirk Myers
324 Elmont Circle
Shippensburg, P A 17257
Re: .g,~lj~~~Lif~ TnsurllI19~P9:mPaIlY Colltra,ct N;o.: SCLSOI082751MNS
Deceased, S. Louise Shelley
Dear Mr. Myers:
Recently we received your request for information on the above-mentioned annuity
contract. This letter is providing you with the information.
The accumulated value of this Contract as of the date of S. Louise Shelley passing,
December 10, 2004 was $55,177.07.
If you have any questions, please contact the ING Service Center Annuity Death Claims
department at 1-877-884-5050 between the hours of8:00 a.m. and 5:00 p.m. CT.
Sincerely,
fttj J~
Mandy J. Burckhard
Policy Services Coordinator
Annuity Death Claims
P.O. Box 5050
Minot, ND 58702-5050
Toll Free: 877 .884.5050 TTY: 888.222.1735
servicecenterla2us.ing. com
...
ING JiaJ
February 4,2005
Kirk Myers
324 Elmont Circle
Shippensburg, P A 17257
Re: Reli.~StfU"Lif~ JnsW'anc~ C()rnPaIlyContractNo.: SCLSOI092699I<.NS
Deceased, S. Louise Shelley
Dear Mr. Myers:
Recently we received your request for information on the above-mentioned annuity
contract. This letter is providing you with the information.
The accumulated value of this Contract as of the date ofS. Louise Shelley passing,
December 10, 2004 was $54,064.02.
If you have any questions, please contact the ING Service Center Annuity Death Claims
department at 1-877-884-5050 between the hours of 8:00 a.m. and 5:00 p.m. CT.
Sincerely,
ItfJ~
Mandy J. Burckhard
Policy Services Coordinator
Annuity Death Claims
P.O. Box 5050
Minot, ND 58702-5050
Toll Free: 877.884.5050 TTY: 888.222.1735
servicecenter@us.ing.com
r'
-
GE Capital Assurance
A GE Financial Assurance Company
GE Capital Assurance
3100Albert Lankford Dr., PO Box 1572
Lynchburg, VA 245051572
Toll Free (800) 221-9501 fax: (434) 948-5783
February 4, 2005
Kirk M. Myers
324 Elmont Circle
Shippingsburg, PA 17257
Re: Estate of S Louise Shelley
Dear Mr. Myers:
As per your request, this letter provides you with date of death value for the tax-deferred annuity
owned by the decedent.
The information is as follows:
n~.()ticXf:tiJumber Desianated Annuity Value. As Of 12/10/2004 Taxable Interest Portion
@$;ODe7lofe2S' $118,847.40 $23,415.49
* The Designated Annuity Value is the total share of the annuity as of death. Interest continues to be credited daily.
If you have any questions regarding the above, please contact me at the above toll-free number,
extension 7826.
Sincerely,
~~-tM
Regina Preston
Annuity Claims Examiner
Enclosure
rop
,
Life and Annuity Claims
P.O. Box 94212
Palatine,IL 60094-4212
December 23, 2004
Charles Little
PNC Bank
2 East Main Street
Mechanicsburg P A 17055
Re:
Administrator for:
~on:tr~<::rNo:
Claimant(s):
S. Louise Shelley
Allstate Life Insurance Company
GA20M65
W. Michael Nailor
Dear Little:
We have been requested to complete Internal Revenue Service (IRS) Form 712 with regard to the
referenced contract.
The purpose of Form 712 is to provide an estate or donor with the value of a life insurance contract or
with its proceeds as of certain date (usually the owner's date of death or date of transfer of the contract).
The contract referenced was an annuity contract, which is not reportable on IRS form 712.
The following information is provided regarding the value of the annuity and other data as of the date
specified:
Date of Death: 12-10-04
AnnuityValue* as of Date of Death: $ 191,399.10
Cost Basis: $146,757.21
Named Beneficiary: W. Michael Nailor
*The actual amount paid may differ due to Market Value Adjustments and/or any applicable Surrender
Charges. .
If you have any questions, or need further assistance, please contact the Customer Care Unit at 1-877-499-
6418.
Sincerely,
Life and Annuity Claims
BJS
Overnight Address: 544 Lakeview Parkway, Vernon Hills, IL 60061
Toll Free Fax: 1-866-635-4523
\ I
08/18/2005 12:13
~
785-295-4495
AMERUS ANNUITY GROUP
PAGE 02/04
AmerUsAnDll ty GI'OUP Co.
555 South Kan~ ~ Ave
Topeka, K5 661 03
1-800-ANNUT' Y
Augu~: t 1f.;, 2005
..4MERUS
Annuity Group
Allen :. Harr. CPA
Starn I: aU~lh Ness, PC
Fax # 717-637-1943
Re: F: :>lic:, #378390 - American Investors Life
II Isured: S. Louise Shelley
Dear I' 'r. Harr:
Than~; yo J for your recent request for information regarding the policy referenced
above The date.of death value is noted below.
Date of Death:
December 10> 2004
Interest Amount:
$57,390.95
$12033.41
Principal Amount:
Account Value:
$69,424.36
If you ' ihould have any questions or need further assistance, please feel free to contact
our oft; ce at 1-888-ANNUITY (1-888-266-8489).
Since,. ~Iy,
Andrei: Shurtz
Claim~: Spl~cialist
..~-
AMERUS
Lv'"
1-888-252-5530
AMERICAN ] ~:TORS LIFE
1-&8 -ANNUITY
rnl~1 .,."lI... t!~IIV'~'
1_'C'"IY'Io"''''''' e>rtM "".,...
08/1~/2005 12:13
785-295-4495
AMERUS ANNUITY GROUP
II
PAGE 03/04
AmerUs Ann\. ity Group Co.
555 South Karl as Aye
Topeka. KS 6~ 03
1-800-ANNUl 'Y
Augu: it 1n, 2005
.AMERUS
Annuity Group
Allen =. ~arr, CPA
Staml,auuh Ness, PC
Fax it 717'-637-1943
Re: F: oliev #447101 - American Investors Life
I lsul'ed: S. Louise Shelley
Dear I ~r. Harr:
Thanl; you for your recent request for information regarding the policy referenced
abOVE! The date .of death value is noted below.
Date of Death:
December 10,2004
Principal Amount
I nterest Amount:
$25,000.00
$1,374.07
$26,374.07
Account Value:
If you lhoufd have any questions or need further assistance I please feel free to contact
ourofl ce Jilt 1-888-ANNUITY (1-888-266-8489).
Sincer !Iy,
Andre; I Shurtz
Claim:: Specialist
AMERICAN r l/VE!ITORS LIFE
..~-
AMHR[lS
1.i/r1
1.88&-252.5530
1-88: -MrruITY
1M 1.11I 'n4M ,Ii JUlVTr.1"l'.l
I""~A'DI\ .cmnrom
~ 08/1~/2005 12:13
785-2g5-44g5
AMERUS ANNUITY GROUP
II
PAGE 04/04
AmcrUs AORlty G mup Co.
555 South Kar! a.~ Aye;
Topeka, KS 6f (13
1-800-ANNUJ Y
Augu it 1U, 2005
.AMERUS
Annuity Group
Allen =. r1arr, CPA
Starn] 'aunh Ness, PC
Fax;!i: 71i'-637-1943
Re: F: oticy #342881 - American Investors Life
I lsul'ed: S. Louise Shelley
Dear) M. Harr:
Thanl' you for your recent request for information regarding the policy referenced
abOVE: The date of death value is noted below.
Date of Death:
December 10j 2004
Principal Amount:
$25,347.74
$6,565.72
$31,913.46
Interest Amount:
Account Value:
If you BholJld have any questions or need further assistance, please feel free to contact
our ofl ce ,ilt 1-888-ANNUITY (1-888-266-8489).
Sincer ~Iy,
Andre; I Shurtz
Claim:: Sp'ecialist
1 ~88; .ANNUITY
,"'c. 'URD" 17D'\,,"'1h
. AMBRvs
Life
1-888-252-5530
AMERICAN]\ WEI;TORS Un:
...~-
~.
~
!!!!!!!!!!!!!!
!iiiiiiiiiiiii
!!!!!!!!!!!!!!
!iiiiiiiiiiiii
~
~
!!!!!!!!!!!!!!
-
~
!!!!!!!!!!!!!!
SuDAmerica
Financial
II
SunAmerica Life Insurance Company
Fixed Annuity Administration
P.O. Box 9006
Amarillo, TX 79105-9006
QUARTERLY GROWTH REPORT OF YOUR POLICY FOR THE QUARTER ENDING 12/31/2004
1-888-333-2349
>02843 0548795 001 008129
S. LOUISE SHELLEY
304 W. MAIN STREET
MECHANICSBURG, PA 17055
Account Information
VL 1433 7 (02102102\
Beginning Value
Interest
Accumulated Value
Surrender Value
m
.~qllti\~~t,~um~~J"
. p~ir~yD;t~'" .
· Annuitant
. Policy Type
· Agent
· Composite
Annual Yield
Current Quarter
10/01/2004 - 12/31/2004
149,186.02
1,207.52
150,393.54
150,393.54
A634051798D
02120/1996
S. Louise Shelley
Non-Qualified
3.25%
Year - To - Date
01/01/2004 - 12/31/2004
145,512.37
4,881.17
150,393.54
150,393.54
LtB0L 11
'" 2o/?;.J S-
2U 1. tRR ClC(;(tt,td.
If\-k,(eGr
A Member of American International Group, Inc.
8129-~
"- '.1MI'!~B\
II
Transamerica Life Insurance and
Annuity Company
Home Office:
Charlotte, North Carolina
Administrative Office:
4333 Edgewood Road NE
PO Box 3183
Cedar Rapids, Iowa 52406-3183
December 23, 2004
Micahel Nailor
651 5th St
Northumberland PA 17857
RE: Mn'\1J;ty :;1l111nher2625,4~
Dear Micahel Nailor:
We have received notification, S Louise Shelley, annuitant of the
above listed qualified tax deferred annuity is deceased. Our office
wishes to extend sincere condolences for your loss.
Our records indicate the following annuity information:
, Annuitant:
Owner:
Primary Beneficiary(ies) :
Annuity Policy Date:
Full Value as of 12/23/2004:
Taxable Portion:
Full Value as of 12/10/2004:
S Louise Shelley
S Louise Shelley
W Michael Nailor
May 17, 2000
$15,067.72
$15,067.72
$15,051.87
The attached document reflects the options available to the primary
beneficiary (ies) listed above.
The full value as of the date of death is for tax purposes only and is
not a guaranteed death benefit amount.
The attached document contains general tax information based on .
Transamerica Life Insurance and Annuity Company's interpretation and
should not be relied upon for your personal tax planning. If you have
questions concerning the direct tax consequences when selecting an
option, you may wish to consult a tax advisor.
Member of the -,EGON. Group
.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.2B0601
HARRISBURG, PA 171 2B-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NAILOR W MICHAEL
651 FIFTH STREET
NORTHUMBERLAND, PA 17857
nn____ fold
ESTATE INFORMATION: SSN: 183- 12-2724
FILE NUMBER: 2104-1155
DECEDENT NAME: SHELLEY SARA LOUISE
DATE OF PAYMENT: 09/08/2005
POSTMARK DATE: 09/07/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 12/10/2004
NO. CD 005779
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $2,878.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$2,878.00
REMARKS:
CHECK# 1012
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
r~EPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
pC
0'"'
'*
REV-1547 EX AFP (06-05)
DATE 11-21-2005
ESTATE OF SHELLEY SARA L
DATE OF DEATH 12-10-2004
FILE NUMBER 21 04-1155
COUNTY CUMBERLAND
ACN 101
APPEAL DATE: 01-20 -2006
( See reverse side under Objections)
AMount ReMittedl I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
~~!_~~~~~_!~!~-~!~~------~---~~!~!~-~~~~~-~~~!!~~-~~~-!~~~-~~~~~p~--~--------------------
REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SHELLEY SARA L FILE NO. 21 04-1155 ACN 101 DATE 11-21-2005
W MICHAEL NAILOR
651 5TH ST
NORTHUMBERLAND PA 17857
TAX RETURN WAS: (X) ACCEPTED AS F I LED
) CHANGED
If an assessMent was issued preViously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ~ returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate
16. Amount of Line 14 taxable at Lineal/Class A rate
17. Amount of Line 14 at Sibling rate
18. Amount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS:
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. Mortgages/Notes Receivable (Schedule DJ (4)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
157,000.00
1.001,612.00
.00
.00
325,875.00
48,579.00
712,905.00
(8)
8.
Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
63,520.00
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
ClO)
.00
Cl1)
Cl2)
Cl3)
Cl4)
NOTE:
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
2,245,971.00
t;3.Ii~D.Dn
2,182,451.00
60,000.00
2,122,451.00
Cl5)
Cl6)
Cl7)
Cl8)
.00 X 00 .00
2,122,451.00 X 045 = 95,510.00
.00 X 12 = .00
.00 X 15 = .00
Cl9)= 95,510.00
PAYMENT RECEII'T DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-07-2005 CD005026 4,631.58 88,000.00
09-07-2005 CD005779 .00 2,878.00
TOTAL TAX CREDIT 95,509.58
BALANCE OF TAX DUE .42
INTEREST AND PEN. .01
TOTAL DUE .43
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. (\~
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE~
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF DETERMINATION AND
ASSESSMENT OF PENNSYLVANIA
ESTATE TAX BASED ON FEDERAL
ESTATE TAX RETURN
REV-483 EX AFP (06-05)
W MICHAEL NAILOR
651 5TH ST
NORTHUMBERLAND PA 17857
DATE 04-24-2006
ESTATE OF SHELLEY SARA L
DATE OF DEATH 12-10-2004
FILE NUMBER 21 04-1155
COUNTY CUMBERLAND
ACN 201
APPEAL DATE: 06-23-2006
(See reverse side under Objections)
Amount Remitted I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment.
~~~ _ ~~~~~ _ ~~~~ _ ~ ~~~ _ _ _ _ _ _ _ _~_ _ KEJAI_N_ _L_O_W_E.!t ..P.!tRJ_I_O.N.. f.9K .~(O_UK f_I_L_E~_ _ ~ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
REV-483 EX AFP (03-05) .. NOTICE OF DETERMINATION AND ASSESSMENT
OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN ..
ESTATE OF SHELLEY
SARA
L FILE NO.21 04-1155
ESTATE TAX DETERMINATION
ACN 201
DATE 04-24-2006
1. Credit For State Death Taxes as Verified
28,369.00
2. Pennsylvania Inheritance Tax Assessed
(Excluding Discount and/or Interest)
90,878.42
3. Inheritance Tax Assessed by Other States
or Territories of the United States
(Excluding Discount and/or Interest)
.00
4. Total Inheritance Tax Assessed
90,878.42
5. Pennsylvania Estate Tax Due
.00
TAX CREDITS:
PAYMENT RECEIPT
DATE NUMBER
". ,
,
,
,
,
;
,
,
.
DISCOUNT (+)
INTEREST/PEN PAID (-)
AMOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
-IF PAID AFTER THIS DATE, SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE
ftlU: . 1:I1:'1:'111..n r'1:1: I:U:::UI:'DC"'I:' C"'Tnl: nil:' 'rUTCO' I:'na.. I:'na T..IC"'TDIII""TTn..lC"' ."
.00
.00
.00
.00
w
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
W MICHAEL NAILOR
651 5TH ST
NORTHUMBERLAND
NOTICE OF DETERMINATION AND
ASSESSMENT OF PENNSYLVANIA
ESTATE TAX BASED ON FEDERAL
CLOSING LETTER
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 280601
HARRISBURG PA 17128-0601
REV-736 EX AFP (06-05)
PA 17857
05-01-2006
SHELLEY
12-10-2004
21 04-1155
CUMBERLAND
202
APPEAL DATE: 06-30-2006
(See reverse side under Objections)
Amount Remitted I
MAKE CHECK PAYABLE AND
SARA
L
I
REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR FILES +-
RE-V=736--EX-irFP--(oi:-02j-----.ii-NO-ficE--OF--OETE-RMIN-Aflo-N-AN-o-As1iEss-MENT-----------------------------
OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER ..
ESTATE OF SHELLEY
SARA
L FILE NO.21 04-1155
ACN 202
DATE 05-01-2006
ESTATE TAX DETERMINATION
1. Credit For State Death Taxes as Verified
28,369.00
2. Pennsylvania Inheritance Tax Assessed
(Excluding Discount and/or Interest)
90,878.42
3. Inheritance Tax Assessed by Other States
or Territories of the United States
(Excluding Discount and/or Interest)
.00
4. Total Inheritance Tax Assessed
90,878.42
5. Pennsylvania Estate Tax Due
.00
6. Amount of Pennsylvania Estate Tax Previously Assessed
Based on Federal Estate Tax Return
.00
7. Additional Pennsylvania Estate Tax Due
.00
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
; -.;01
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
-IF PAID AFTER THIS DATE, SEE REVERSE SIDE lIF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED C
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ, YOU MAY BE
---.. --- --.------------
))
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 11/30/2006
NAILOR W MICHAEL
651 FIFTH STREET
NORTHUMBERLAND, PA 17857
RE: Estate of SHELLEY SARA LOUISE
File Number: 2004-01155
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by: 12/10/2006
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
Sincerely,
~~~
. 1 ' .
,",. ,.,.,..'". :
Glenda Farner Strasbaui
Clerk of the Orphans' Court
cc: File
Counsel
Pa. D.C. Rule 6.12 STATUS REPORT
REGISTER OF WILLS OF fL,/Ji',!JCd! '-Ff-tU 0 COUNTY, PENNSYL V ANlA
Name of Decedent: c-~t9-~n Lau/se= SH~LL~y
Date of Death: /2 -It') " 2-CJj(/Lf File Number: 2L/&L/ - tJ /155
Pursuant to Pa. O.C. Rule 6.12, 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: . . . . . . . . . . . . . . . . . . .. ~es
DNo
2. lfthe answer is No, state when the personal representative
reasonably believes that the administration will be complete:
3. lfthe answer to No.1 is YES, state the following:
a. Did the personal representative file a final account with the Court? . . . . . " D Yes ~o
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? ............................... C! Yes D No
d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be
filed with the Clerk of the Orphans' Court and may be attached to this report.
Date
/~$7~d?t:/b
,
#/.~a/#~
Signature of Person Filing this Form
Capacity: ~rsonal Representative 0 Counsel
=J(J >leJ:J1J
It/I /HI CI/.4c '- A/ A / LtJ/2-
Name of Person Filing this Form
6.~-/ RPrl/ ~)r..eEET
Alb~/I/I//J1t5E?<.L,l/-Np .IJ? IZf5l
,
S-70'-~73-3bot
Telephone
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