HomeMy WebLinkAbout06-27-13 _ _ __ _ .
J 150561�101
REV-1500 °`�°'_'°> d�1
WaMa �FFICIAL USE ONLY
PA Department of Revenue Pe!��Y County Code Year File uMber
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX z8o6oi
Harrisbu ,PA i9f28-o6oi RESIDENT DECEDENT � � z � 7
ENTER DECEDENT INFORMATION BELOW � ���
Social Secunty Number D��D�th� ��YYYY Date of Birth MMDDYYYY
� s�i 9 � �
DecedenPs Last Name Suffix DecedenPs First Name '� MI
NSN � ! �
(If Applicable)Enter Surviving Spouse's Information Below �
Spouse's Last Name Su�x Spouse's Piret Name �� MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
�'��� REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW '�
� 1.Original Return O 2. Supplemental Return O 3. Remainder Retum(d te�lof death
priorto 12-13-82) '�,
p 4. Limited Estate O 4a. Future Interest Compromise(date of O 5. Federal Estate Tax R tu}n Required
death after 12-12-82) '�
i 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust _ 8. Total Number of Safe �posit Bozes
(Attach Copy of Will) (Attach Copy of Trust) ',
O 9. Litigation Proceeds Received O 70.Spousal Poverty Credit(date of death O 11. Election to tax under e�.9113(A)
. between 1231-91 and 1-1-95) (Attach Sch.O)..�; �
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMRSION SHOULD�IR C
Name Daytim elBphone N be �
CH � � L � N L S 1 / I 71 G 9
I�E F �baL
� T ip :.�
O � �� �, -�:l
0 �� �
First line of address n �' " � �w r j
o ` . � :
C [. �l D �4 _ ; �, - �:,
�, o I� �:,
Second line of address � T" G.J '..
-�,
Cl�y Of Post OffICC � Sl2fB ZIP COdO DATE FILE
C N /1 �., l C S ���. � ��9T7 ,,.. ,,_
p/� �. �
Correapondent'se-mailaddress: (�S�/e/�SJ(T1 �1�/YICQS/. n� �
Untler penal[ies of perjury,I deUare that I have examined ihis retum,inGUtling accompanying schedules and statemenls,and to the best of my kn wl dge and belief,
it is tnie,cortect and complete.DeGaration of pre other than the personal representative is based on all in/ormetion of which preparer has n knowledge.
SIGNATURE OF LE F ILING RETURN DATE
— � nA ��
ADDRESS �R�C C• �NSH �2 m;iic,- ar�a, /A'eCha�%cs6N/�� /��7 �T� '.
�
SIGNATURE EPA OTFf�t TH RE ATIVE� DATE � �
x � n�/ A �
ADDRESS �y�.Q�� E. �,F//t�5 � � C�OUSGt� Rp,� �`��Cs6MI�� T � s.�
PLEASE USE ORIGINAL FORM ONLY I
Side 1
� 1505610101 1505610101 �
, ��'
�
J 150561U105
REV-1500 EX
DecedenCS Social Security Number
� Decedenfs Name: �o If/� IS. �HS�'1 � ! ��
RECAPITUUITION
1. Real Estate(ScheduleA). . ... �.. ... .. . . �... .. . ... .. . . ... ... .. .. .... 1. � � . (�„� .,��r���;y �.0 �
2. Stocks and Bonds(SChedule B) .. ... ...... .. ... ... ... ... .. . .. ... ... .. . 2. . ; �� � �
3. Closely Held Corporation, Partnership or Sde-Proprietorship(Schedule C) . .. .. 3. 0 �
4. Mortgages and Notes Receivable(Schedule D) .. . .. . .. ... . .. .. . .. . .. ... .. 4. .Q 0
5. Cash,Bank Deposits and Miscelleneous Personal Property(Schedule E)... . .. . 5. . � 7 , � � � � `
6. Jointly Owned Property(Schedule F) p Separele Billing Requested . .. . .. . 6. �' '� Q
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property . e
(Schedule G) O Separate BiNing Requested.. ... .. . 7. ' .3 �.. 3 � 7
8. Total Gross Assets(total Lines 1 tbrough 7). .. . .. . . . .. . . . . . . . . . .. . .. . .. . 8. � . .S � .� p. $ .:.
9. Funeral Expenses and Administrative Costs(Schedule H).. . . . .. . .. . .. .. . . . . 9. � 7 .. O
10. Debts of Decedent Mortgage Liabilities,and Liens(Schedule I) . . . .. . .. . .. . .. 10. g �
11. Total Deductlons(total Lines 9 and 10). . . . . .. . .. . . . . .. . . . . . . .. . . . . . . . . . 11. p
12. Net Valua of Estate(line 8 minus Line 11) .. . .. . . . . . . . . . . . . .. . . . . . . .. . . . 12. . l�
13. Charitable and C�ovemmental Bequests/Sec 9113 Trusts for which
an election to.2aa.has not been made(Schedule J) .. . . . . .. . .. .. . .. . . .�... . . 13: Q � �� �Q O
14. Nei Value SubJeet to Tax(Line 12 minus Line 73) . . . . . . .. . .. . . . . . . .. . .. . . 14. � . � 5 1 �P Z.
TAX CALCUlAT10N-SEE INSTRUCTIONS FOR APPIICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rete,or
transfers under Sec. 9116 • i'Vr r.. . �
(a)(12)X.O.Q. .��•���� � � � 15. I Q 'O
16. Amount of Line 14 taxable 7 .
at lineal rate x.o� Ir � ,). 4 2 � i6 I �
17. Amount of Line 14 taxable
at sibling rate X.12 � � 17. �
18. Amount of Line 14 tazQble , �
at collateral rate X.15 0 � � ig. �
19. TA7(DUE . . .. .. . .. . . . .. . .. ... .. ... . .. . .. . .. ... . . . ........ �.:..... ... 19: , .. � � 7 .s : .3 �
20. FILI IN THE OVAL IP YOU ARE REOUESTING A REFUND OF AN OVERPAYMENT p
Side 2
L 1505610105 1505610105 J
_ _ ._ _ I I
COMMONWEAITN OF PENNSVLVANIA HtV->>bl E%�1�-yb)
OEPAftTMEM OFREVENUE I .
�URI[AU CF INIJIViDUAL TAXES �'�,
OEPT.280601 �i
� HARFISdURG,PAI]128�O601 ' �i
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX ,
OFFICIAL RECEIPT
NO. CD 016�94
�
BUSH ERIC C �I
572 MILLER BOULEVARD
MECHANICSBURG, PA 00000 I
ACN
ASSESSMENT AMOUN I,
CONTROL
NUMBER
----- �a�a --------- --------
101 � 518,168.
ESTATE INFORMATION: ssN: �
FILE NUMBER: 2112-1077 I
DECEDENT NAME: BUSH JOHN K �
DATEOFPAYMENT: 12/07/2012 �
POSTMARK DATE: 12J07/2012 �
CouNTV: CUMBERLAND �
DATEOFDEATH: O9/14/2012 �
�
TOTAL AMOUNT PAID: 518,168 75
REMARKS: RECEIPT TO ATTY
CHECK# 108
INITIALS: DMB
SEAL RECEIVED BY: GLENDA FARNER STRASBA H
REGISTER OF WILLS
TAXPAVER �.
�
I
II
.
CHARLES E. SHIELDS, III I
�ATTORNEY-AT-IAW I�
�
6 CLOUSER ROAD i �
� Comer of Tnndle and Clouser Rnads �i .
- MECHANICSBURG,PA 17055 ''�
GFARGE M.HOUCK TELFPNONE (717) 766-0209
p912-1991) FAX ('�1� 795-7473
June 14,2013 ,
I
i
Register of Wills I
Cumberland County Court House ',
1 Courthouse Square 'I
Cazlisle, PA 17013
Re: Estate of John K.Bush I
No.21-12-1077
Deaz Register of Wills:
Please find enclosed Check No. 113 in the amount of$3,634.31 in payment for the
Inheritance Tax for the Estate of John K.Bush. We anticipate sending the Inheritance Tax
Return with the filing fee and additional probate within several days.
Thank you for your kind atten6on to this matter.
Very tnily yours,
��%���2�.C/� � '�a���
Chazles E. Shields,III
Attomey-At-Law
CES/mjj
Enciosure
i
I
I
,
�
__ _ _ _ ___ �_
�i
��
I
�
� N 113
1�1.M���.
���
DATE � �3 -ezzuzt�s
PAV . ,...,.._ ...
TOTHE �PE�isTFa ��' Gc%//s- . . $�...... a/V
ORDER OF �`�/
�—� / ... V T... ?.
_ i'�2 �/GlauSrX . �S �� — I . �. ,40( "3! JiY— DOLLARS
V Foa lnfiei.fb�ce T.Qk a ,"•.
ESTATE O JOHN BUSH
i w
M
u•000 i 1 3i�' r�: 2 3 138 2 24 i�: 2 18480646 7u'
I
�I
I
�I
I
i
I
4 �
_ _ �
REV-1500 EX Page 3 Fila Number ����z ��� 7/ �
Decedent's Complete Address:
DECEDENTSNAME
JoHn �(. 8uS�1
STREETADORESS �
__ 3,ZS l��s� Dr;✓e� /�pf. 333 - _
cin srA� �� — zia -90 SS
n1 ecl,a.�t;�sbu
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) � (�) 2 ,� 7S 3�
2. CreditslPayments
A.Prior Payments __��� ��0 8� 7S _
B.Discount G�Jr'6 2$ �
Tofal Credits(A+g) (y) �9 Z S. v v
3. Interest
(3) �
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT.
FIII in oval on Page 2,Line 20 to request a refund. (q) �
5. If Line 1 +Line 3 is greater than Line 2,enter the dfierence.This is the TAX DUE. (5) ��31
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE B pCKS
1. Did decedent make a transfer and: Yes N
a. retain the use or income of the property transferred:.......................................................................................... ❑
b. retain the right to designale who shall use the property hansferred or its income:............................................ ❑
c. retain a reversionary inte2st�or.......................................................................................................................... ❑
d. receive the promise for life of either paymenls,benefits or care?...................................................................... ❑
2. If death occurred after Dec. 12, 1982,did decedent transfer propery within one year of death
without receiving adequate consideration?.............................................................................................................. ❑
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. �
4. Did decedent own an individual retirement account,annuity or other non-probafe property,which
contains a beneficiary designation? ........................................................................................................................ �
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART THE RETURN.
For dates of death on or afler July 1, 1994,and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of t e surviving spouse is
3 percent�72 P.S.§9116(a)(1.1)(i)1.
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S. §9116(a) (1.1) (ii)].The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for di Iqsure of assets and
filing a tax return are stiil applicable even if the surviving spouse is lhe only beneficiary.
For dates of death on or after July 1,20Q0:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use o a natural parent, an
adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)].
. The fax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, eMcept as noted in
72 P.S.§9116(12)[72 P.S.§9116(a)(1)1.
• The tax rate imposed on the net value of transfers to or for the use of the decedenPs siblings is 12 percent[72 P.S.§9116(a)(1.3)].A si lirjg is defined, under
Section 9102,as an indiwdual who has at least one parent in common with the decedent,whether by blood or adoption.
_ _ _ _ _ _ �
�.,srea.aan I
SCHEDULE E �I
conwonwFUn�oFaEriNSV�vnqw CASH, BANK DEPOSITS, 8� MISC. I
INNREEPoT����o� PERSONAL PROPERTY
ESTA7E OF FILE NUMBER
7'oho K. 3us1► 2�-/z �077
Indude the O�eeds of IiGgaOOn and the da�Ihe proceedswere recerved by IM esfete.AY property JoiMly�owned wMh ths riqM oF surv(ronhip muat be on ScheOuk F.
ITEM L E AT DATE
NUMBER DESCRIPTION � F DEATH
, Mem bu-s Ist F�du�al Cre�l�t I�nio�
A. 'Re9�lar �av;r�s /1-c�J: N.. a�F 3 951-00 � �OD
8. Chc�K;a� �s�: Nc. a�f39si-il � fl Y• �Y
C_ 2�Stment Sar;r�s A-�f: �'o. �y3 9Sl- oS �l�l, �5�3.93
D, Accr. In�' � d•o.d. en Zttn� C ��• ��
(see va/etaf;ori Shm1' affach«J)
a. �pvereiyn BnnK
i4. ChteXln ��. Nc. ,�33 /o� 98GS * �/3, yOn. 8'1
/3. /�cCr: �t �c d.o.d. o.� 71zi»A• I!'� • ol
(S�va/uafiovt 5fieef a�f4tckt�� '
��'r,�v. notc: Tvintly Gsr� ou�nc/' Sti;r/ey� /1asLi r�as du•rd- '
entS Spbu� wlw /�rcdcceasea�tiu�)
3, lEhic �nsur. lo., ,Dprfja/ re�nd on l�i.l•�'r,r,t �nswr. ��oo
5! N.$�irx.srk� /Ylecl.'ta/ ,Trsur. �ruayc �te�u»d 4.07
�' �F►it �nsw-. L'o., endorsan�nt �e�r..,d �,7,op
6. oSm/e sF p`ssen�u' cau-Mniob���. �-�+re.y{, k�essolr C'ar '
�So.les e� b:I1s6K.�►, P/f' �' �'►a.nda �oylor. Ty.� .As�ehn t6 .�
.
'1 d�� - ,
7 �• �ipt. ef �aenue - Re: 1�rsonal s.�e.ome �� '` �6. �s
8. ��kr'/'isbur� ��n�tiony— �2►'i'ia.� rt�,►'k� on '�i eKe�s � 7r0.00
9. /,3e�iQnf• !/.%/aye, �aiha/re{u,rd o., mainfena,w. �r � �9.�0
/� GoillCa.st /�,0.3/
//. �o.s/� %n !s's//.t
��DO
/�. /h.'se. �.eny��i :os {aa.so� :n a�arJ`'nrvrt q/z
�5�� ��h�. �'��
TOTAL(Also enter on line 5,RecapiNlation) S � 7 � i,/el`�,3(r
Qf more space is needed,insert additional shce4s of ihe same size)
__ _ __ _
_ _ _ _
/J�yr� 2 i SCal�o. �. I�
� I
_._ , �'Si or _ �o�n k•__Bush __ �it.E-nb. -/.[/0�7
__ __ _ _ _ __ _
_ �3- f �Grizen, �t�i.,�d--ean-etlJ �� -- . f&Z� _.
_ iY /fFShtir�• _._�'o_4ti�,cn�t�is��4,I�ar/�aL 7?�{wr�l ax /.��. `i%/g�r
_ y� _. _ __--
-_ _ i4pp/,cahvrl_����_ a�r�/_•�cur,t_.G�es:f. 1�3� 65s89
1_S,1 �ric Snsur. Ca, _�hr/s'nJ rcfwn�l oH p3.�.�,ob;l� ins�r, _. '` 7Sl, �'
_ __lF. j?ers�a l ty__._ _ __ _ __.
_ _ __.
_. �•_.Kr,p� . __�ri� $ush . _ _ _. f��Sa,
� 8, lC¢�oE 111,t�k �IS(i _ _ � 3Sb.°e _.
_ _ { C- IKe� __ T;._ �'if/ls�_ _ _ �.35.eo . .
_ � 'A- _�of � ,�u_.Fu�i/y . - _ _ �57�.eo
i l See i�C/!!/te4�/�i.✓u?ID�;es �etti¢dJ
�? � R�d eF Ged:#_��� u.�.�J C�h �.k t�r.+�d ��.:�;sG.er _ , fiz�.8r
_ _Iff.' �et�,n�►� _V,"ll n,y�.. �- .�pos;t (!�i„ncl _ . '�SDO.�
_ _
_ _ _ _ _
_ __ _
_ ___
_
. . __ _
_ . _ _ __ __ __. _
_ _ . ___
_ __ _
__ __ __
_ __. _ _ -_
_ _ __
_ __ _ _
__ _
_ _ _ _ _
_. .
. _ __ _.
. i _ _. _ _
_ � __ _ _ __ _ __
_ __ _ . _
_ _ _ __.
_
I _ _
_ _ � _. _ _ _
�
. _ _ � _ _ _ _ _ __ _ __ .
___ � _ _ _ ___ _ _ _ _ _ _
� _ _ _ _.
.
�
� _ _ __ _ _ _
i _ _ _
_ �_ _ _ _ _ _
,
; _ __
— • . _ �.. J: _R„ .,,,,
St
.
MEMBERS 1"
�EDPRAI CRID117'UNfON .
REGULAR SAVINGS ACCOUNT•
Account NumbedSuffix 243951-00
Date Account Established pq/23n00q
Principal Balance at Date of Death $25.00
Accrued Interest to Date of Death $0.00
Total Principal and Accrued Interest $25.00
Name of Joint Owner None
CHECKING ACCOUNT:
Account NumbedSuffix 24 3 9 51-1 7
Date Account Established 04R3/2004
Principal Balance at Date of Death $851.74
Accrued Interest to Date of Deafh $0.00
Total Principal and Accrued Interest $g5�.74
Name of Joint Owner None
INVE3TMENT 3AVING3 ACCOUNT•
Account NumbedSuffbc 243951-05
Date Account Established 02/02/2007
Principal Balance at Date of Death $18,743.93
Accrued Interest to Date of Death $2,1�
Total Principal and Accrued Interest $19,746.04
Name of Joint Owner None
MEMBERS 1�FEDERAL CREDIT UNION
Tessa L�`�/
Lending Insurance Support Specialist
October 18, 2012
Estate of:JOHN K BUSH
Date oi Death: 09/1M2012
Sociai Security Number: 194-28-8718
5000 Louise Drive • P.O.Box 40 • Mechanicsburg,Pennsy7vania 17055 • (800) 2g3_232g • wu•w,members stoxg
� .. . . .. . ._. .. r r+w...K: Y f{ 3 7 L G �J'fl f'.:E'R'1'F Y �/ / � .
Sovereign I . -
� Court Ordered Processing\Decedents- MA I-MB3-02-]0 - P.O.Box 841005 - Boston,MA 022 4
�
i
� November 1, 2012
�
a
Y
� Charles E. Shields, III
� Attorney at Law
6 Clouser Rd
1 Mechanicsburg, PA 17055
�
� RE: Estate of John K. Bush
� Date of Death: 09/14/2012
�
�
� Dear Sir or Madam:
�
� Per your request, enclosed please find the account information as of the date of eath
� for the above-named decedent. For your information, accrued interest is not inclu ed in
the date of death balance.
� Please feel free to contact me if I can be of any further assistance.
f
}
; Very truly yours,
� �{�.�... w ����;�. �-
a
� Donna M. Long
� Lead Specialist
� Phone: 617-514-5189 '
Fax: 617-533-1931
"'s
0
�
�q
d
t
�qp
6
�
�
�
�
S
z{
d
�
_
I
i
Sovereign Bank '
ESTATE OF John K. Bush I
SOCIAL SECURTTY#: 194-28-8718
DATE OF DEATH: September 14,2012
Account#: 2331029865 Type: Checking Open date: 3/5/19 9
In the name of: John K. Bush or Shirley R. Bush
Date of Death Balance: $13,100.81
Int.(YTD)from 1/1/2012 to 9/13/2012 $1.23
Accrued interest to date of death: $0.01
Otherinfo: Account Closed 10/18/2012
Account#: 4539091670 Type: Home Equity Line of Credit Open date: ll/I S/2 08
In the name of: John K. Bush or Shirley R. Bush
Balance due upon death: $0.00
Int.(YTD)from to
Accrued interest to date of death:
Otherinfo: Loan closed 11/16/20ll
Page 1 of 1
__
� _
� � �
Jo//� K, BlLSH E3r ,hcF No. �!-/�-�/o�7
�.!�_!��..f'�`xso�rA�zY.��'rE.dTv.�� .__Bur'NvT.�rECre� . f� F.x�a
- ----
/ ' �.
O
� WO�, !l G� �
-----. _._--,�___—_
-- ----. _ _ ---__ ___.._ - ---------
: � �� ---t-- ------
�O//1 �CCld1(/--- -------_._._ T/ ,o0
---- -- _._ --- _- -------
�-�-_a_ ___ �� _ �
,°o
3 .e� l�vr.r .ne.- _____-----__ . . ---- ----------- -�
--_ _ .—.�
� -----
__ _--�`y�- ����----- -- -- --___ ------ ----__-----�a ••�- - --
---------s-��-�-��� - - � •�-----
��— --- -- ---- --- ----
_ _ _� �� � _ .T��.l��_ ____ _____ -- -- -- _ _ .__ '�� •��__._ _----
-- ---t-_`�-_' � _�1!�c-_���-------- .___. f .eo
__- --- --- --
_�_- —
.___ _�'-i+�_2���►r_�---- _ __-- -__ - --- --- � '"°
' _Qy�t_ �_v!_.fz�te�rc.__.G!�i _�f__��_�/�•cff.rts _ f` _ '�
�
p 4j _ __ _ __
__ n_ .--� ___ p���l1� ��- �� �
_- ---__ __ --- --- ---
- ---
--- - _�, .t _ _�C �L--- ----- �i �
_ _ -- — -- --- --- — --- - ---
__
_ ��.-� _����/ _-_ ----- --- - ----_ --- -�� '-°°--� -
_ _
. _13 ��_---------- -- - -- ,�i . o0
- - - - -- -- ------
� 1�ss°rf'� �cfurra � -°°
---
. _l ��.----- --_ ---_ --- --- --. ___- --- -_.
---- - -_�.cc�--- �
___ -� -� ----------------------- '
—._
---_ --.--�. . �As.w��' CDs�`�'�_- ---------------� 'B'
----
� _r�i��� ' o,r.s r.r�e- �,�s --------- _- — .e�
—._�_
_—__--1� .�ia� %!s-------- ---- ' .�
---- ----_
1f. �t:nitss oS'jL't/1��L1 s.� -__ � .ee
----_ - -- ---------_—_ __
------ --� _.O/ /�'lth/ F>I w�,---------------------- � '°°---
�. �/CSS i�%hYllls' !y/hCL +� � � .nG
--_ __—_ ._
-- ---— _
a� / --- — -- -------- ---
_
__.�� __CX�kd bBo�CaSt � • O°
A- t ---
�----_-- -- - -- --- --
--__.___.�_ �._/1��i�r.v� i/�rt� /��<�s__��s .G� ---- - ------- �/S. °°
,,� _-� / ,/� � � ------
- ai• .C�C�lI!lIA� /�O_�r[�t�ari�s- ------ � S.�-'--
- -- _------ -
• ���� f o, �
_ _ _ __._.
--- _ — --_ . ---- - ----- --
--
__26 %an�t L; � 1����e i.� �f�a_-- --- -------'�� �°-------
` �,scc C�ivih%���, she�
_--- - _ � _ -- -------_ _... —.-----____-- ----
�
I
_ _ _ i
i< <Jdy/n/ . 3N.S _
K /f EsT FitE .✓o. ,2/ i -/077
_� z�;.�.�kso�cfk?Y_..,�NL'E.✓�T��e� __1�. ���. � �.__-
a�,; i f�u.L (] 7'r s�ev.,�t T�txs ___ __ .___�..______�_ �s• _ .__..___._. .
a�. �I FDGD/N6 'l�1�.'O �►�,F-� �ly� ��.,�s �is _.�__---
__ a� �� �i�GT!'�S!�� ��co �cT,e�� G�►S�EE 1{�___._____.��-�- . --
30_ �� �/ssoa�� �l�r�. .�i�E-N uT�irsics-----_�______.______ ��. "° ___..__,�_
i�_�
3�. iI .frlml�rr,D R�7sS�if�ris ------- -------___.__- �io.�o �_._�_
r� �
3z.�� D�3.� lS�s��i.c' ____---�___.�_._______.�••�_____,
_ 33�� �ASSbaT�D X�t�s D��Tim.,�s '` _'°�.__..�_
_..__� ___.__—
t
--- -__��,:__,/f�Tl�1L'/� X-AlAS T.CEF__._._ . ----- ----._._ _..__. �%o no
--------+'�------___ ------------------------- __.� .__--------
-----�---- -- — — _ ,
� -- -------------___..— -_.__�.
-� - --- --_
--'-r-- - — -------
i
i
___--�—__-- -- -------- - — --
`� — -- — --- - ------
' I
;
----�—_ ------. _.�-- - ----
�— -- ----------- --
---�{-- — -
_�� _- — ------ --
; �
�._._� �� --- --
! 1
_ �_ �
------+-�---------- ------ --------------
i
�
-----�+-- ------------------------�_._.�_..� _.__
----<-�--- ----------- ------ ---.�.__
i
-- � ----- --- �
�
�
--+-�---- — - -- —
----�+------__ __—...---
-------- ------
,, �
_ _ _ _ _
,,
I
i '; ,7�oHN ,� BuSH E5?. fiic�- iro. ��� /2-la77
i ;
__._ ��--P�RSoN�ILT_�.—.T_ �'R/C BusN: _ _,----.------._______ �. �..�
f ��
—.__�_L_.' ��NaP�� ----- --__. .DD �--
2. 1 /�.� !.✓a,� � �e ____ '�io .o0
` '`,�a .00
;
--------_ t __. _- --- -�_.--_.�.__ - ---
�---- i saN _T,�� /19�.0 Bsts.r�.-._-- ------ —
—"_" T � " <CD !v _ _ '`�� .00 ___.m
--- j�� � _� ¢ .°'' .._._
�
—..�.�T -----
� � -[ � 5[ .OO �
i.��[
, t��----- ...__.�..----- . . ___-- � ---.__ ._._--.__.-.--'-.. . �--`------_
---�---__--.,-'� //S 00 �
� � .S!��_-._.
� .----------- ---°-
--_.---- ,t' -_-._._._
--5�' � _ O - L5 —;' - --- ------- �s �
� ---- ----- --
3 5 .o0
;
-- ' -- ---
_, i
�
� E�pso�acTY T �i� i .y �
� _
---- � � , �l,�et __ ---- � 'ao
. . s.7 _ao
3 ? ��. � .on
�f, ! l�ec�li.�.�`� a/G. i�` .ao
r. — � °°
i ¢/3 .a0
--- �
- -------� ---- --
-----------{t --— ---- - -
--�----- — ----__---------- — -- —
� � ---- — - --
---n ---
---�-- --------- -------__.-----
;
_------��----- --___ _ __----._J_------ - �--
`�, I
�, �
__ __ _ _. . _
� _ __
� REV-1510 EX+(OB-09) I
'�i� pennsylvania SCHEDULE G '
� OEPARTMENTOFNEVENUE INTER-VIVOS TRANSFERS AND
INHERITANCETqX0.ENRN MISC. NON-PROBATE PROPERTY ,
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
1�ohn K. BuSli oL/-/2- 077
This schetlule mus[be mmpleted arM fled if the answer to any of questions I Mrough 4 on page three of the REV-1500 is yes.
REM DESCRIVf10N OF PROPER7Y
. uxiuoe�xe�am�m�xs�e,nwana.masH�oTOOC�r�rnno DAlEOFDEATH %OFDECDS IXCLUSION TAXABLE
NUMBER 1HEWlEOfiRHi5fE0.. AT�,IpIRCOWOFINFDH�DF00.RFI1.6TAiF. VALUEOFASSET INTEREST �nrn�c�e� VALUE
'' ?hr� ✓G»t�LHf�,crrtn Srot$crkeod��eeounts, ol/
�-f` wh;ati ar� edlir �rR.�s�.- oe �Ou f�
�c�0u�1's or �C�O�ats w%/�i dtsi,Aa,�
bcac�i"ciari�s. �1p � � �ew arc A:'r,��
inf �iric�3) e�ua/ cS�ArCS �/no/t�:
T�r m�v�eiE ,rir•vr� ,�ddauyti�;
n7.f�K A-. SNSH, �r
�Q/C L�. t'3NSH Ss�
,4�. 20� i,�a ,�LC �l32 /�8� Y9,f�ig. /oo,v —o — y9, �is.sz
B. �'�eaoiTOn�A� i�eA �[c '�37 yano 8-,��� /ooY —n_ �`���ri 9�
� r,�.�oir�,v�c �,ef � 9r�9� �a �s�8o9o'° � �°
� /ao� -o - �8, o9a
D. z✓o�r. r�ltr�llilt Frr.s�s ite�T sE TY f�-
/5�0 S''/3 /61/�Nl.� /oo'o -o-� %67,/yY So
7���vFe NoT6- i¢ iW//aE G�FE /rYSUq? /s
/NCLkDED p✓ �E T�O,y �/i4GUA�TiaN�/EZr'
�,B T.¢iNED Seon� TN.�ivO✓T�¢T�flE.D
/lE.�ETp. �flo�fr�v�, 7y�s �s �YoA'-ASsESs
/�i3l� -fv.l' p•4. /NNE�2. Ti1jr /°a.?,00StS
.9�N0 ffAs 7N6PET-77.pE /YO�' .9EGav G5Ta�
TOTAL(Alw enter on Line 7, Recapi[ulation) ¢ 3 S,? y I.�9
tf more space is needed,use additional sheets of paper of the same size.
_ _ _ _ _
_ � _
II,
i
� c n m rv rv oMO. a
� � n um1 O e�+f .�-� oNo
� t" C N I� O 1� 'i
C S e�l N O a�-I ��A t�0
W
m �'y
p N M Of 00 � t!1 M
'i
d � a n � o � vai
� N m � oo a6 r� o
> m a � � a � v
Y � M 1� 00 � �/1 .--I .
Ec .00-in .��+ °mv rn
a+ e �c .� o .. �n
� L �T Ot N V � 00
Q � rl a-1 �
Q p
O � y �
M � � V
q � � �
Q � � Z 2 �
c
�, � o
n
.0 .0 o �
C C Y C
Q Q w C J
� y y � w LL
3 a a a+ E m
� m m °� �
• � L w J
a > > 3 �n �
�. � � � o°
> _ � _ �
~ Q � � � �
C p� O N O 9
3 i+ C �+ .
O L D — � >
V O R w � 9
Q � H � 1- C
N
M
O
v� N
Y
C a
3 �y
N O �
� a
m `o w � r. g �
]C �
C E � o m m o °m �
t � �v� �+ < < � N �'
O Vl Q Q J J V1 Ol �
a�v-isn ex.�iaos> _
SCHEDULE N '
COMMONWEAL7H OF PENNSriVANiA FUNERAL EXPENSES 8t . '',.
INHEPRANCE TAX REfURN ADMINISTRATIVE COSTS
RESIDENTDECEDENT '
ESTpTE OF FlLE NUMBER
?ohn K. 3ush al_1z _t „
Dabts of tlaeetleM must De reporled on Se�etlule L �
REM
NUMBER DESCRIPTION AM UNT
A. FUNERALEXPENSES:
1 I-�o�rtG s�' �a,MP {�i II�/�A �� b��anct qktt eN
Mussc�man �xneral
P^�Pa;d �'u»u�al Fund, -�fowcrs, d�0.lf� ecr/-;{,i�t: fY3 .64
�. TriAify0 Eran9c%'ca/ Lkllicn� an C�6u�cl, sf G�tnyo /1://. P.I �.- s
[LSC M' /tal�j Tt[/!C/�N /11tp./� LtZ- 7� � ZZ
3, �Qiin,b. �n AJ�rd{ Bash �r �a�.inu.�l" �T RSSOtJ� HARD/AN y .00
e. ADMINISTRATIVE COSTS:
� 1. Personal Re{xesenmtive's Commissions d_ �
T
Name of Personal Representabve(s) �ri C G BuSh _ 'S� �. 78
S[reelAddress 57z m���Lr UI✓d- �
� Ciry /Yler,hanicsburw s�� /'/T Lp �70SS �
Year(s)Commissbn Paid: �
2. AttomeyFees Clte.rles �, o�h�Pi��7i � � � ` 8• !. Z.03
7. Family Exemptiore(If tlecetlenYS address is not Me same as GaimanYs,atfad�expl�ation)
c�aimait II10 pN6r EL/6IliGE /�/ E
s�tnaare�
ciry smie zv
Relationship of Claimant to DecedeM �
a. �onaceF�s and ori8�►w.l iss� oF Sh�r'�' ��cats �Ila.SO
5. AccnuntanCS Fees � �;�G�ecs. .�- a.tntndn�cn� �01 I ���
.},�s, elxab�.t �wro r Ok'►o r prcP 4.a,Fiu».f ¢S D.cY!
6. TazRetumPraparersFees �04) cwd pk yl �¢StiM•� � -
'. /jd✓e+-fs"s:n� in Cr.�ni,Errlovhd La� Sokrrw.� f7 00
� A�w/vs�f�s:n� :s� �ar/.5/e ost�l}ine/ �u✓S�aPu" �/yc ,q6
.
4, Rc%mb: to Chts, �', Sh;elc% � �r VQlu��S'mn {c� 1e
�re�t;qn SaxK � .�
/O, /Pein�L. � M�rK 8�/� �. f� f� dro��/�[ �faf-SPCfi ' .eo
(.See G�onfi:�. s/xef�
TOTAL(Also enter on 6ne 9,Recapitulatbn) S /7r �a' a 3
� (If mOre spece is neetled,insert additional sheets ot IM Seme size)
. i
; I
� 2 5G{�. H I'�
__ _ _- �ST_n� __J_olzn_11 _.Fas�i __ Fic� ao. _ /-/2�0�7
_ _ _ __ _ _
�
. �(: /Qtint6 � MR►K BwSI, 'Tor �mcn.f; '� keu5�*•��_ .Me✓cYt _ _. ��'Od
_ _ l�3. ; /�i��n6. � __Clsrl�s_E_ �'li•elds � _�r _�oslay�_�erfi'�iey�/1�,%yt�s._ - -
_
__ _._. j �o�??yc, �fi. �tsfirn.)�_f�Cb�L4 __ _ Jd 21o.ov
r�� - _ _ _
- -
/_3 � �ddi�e/la/ fproda�_�t� __Y12 �B�tSr'!� nf !%'.%/s _ .f� -
_ .00
_ i� F,/1� �� _ r R�y;s/Z.-oF _ w:ir6 _ _ _�r�s
_ .�
, .
�
� _ _ _ _
_ � _ _ _ _ _
1 . _ _ _ _ __ _
_ . _ , _ __ _ _ _
, __ _ ___
�
_ _ _ � __ _._ _. _ _ __- _
___ , _ _ ___ __ __ _ _ _
_ _ � _ _- _ _ _ _
_ __ _ -
. _ _ . _ _ _ __ _ _ _ _ _ _
_ _ _ _ _ . _ _ _. _ _ _ _
: :: t - - . :
_ _. I _ __ _ _ .
_ ._ _ __ _ _ _ _ . _ _ __ _ _
_ _ __ _ _. _ _ _ .
_
__ _ _ 1 ._ _ _ _ _ _ ._ _ _ _
� . . . . __
r _ _
. ,
REV-1512 EX+(12-03) I
scNE�u�E i i
coMn�oNw�v.ni oF rerxisnv,wu DEBT$ OF DKEDENT, I
'NRESIADENfD C DRE T� MORTGAGE LIABILITIES, & UENS j -
ESTATE OF �ohn FILE NUM ER
K. $ksh �.!-/z /07�
Report debts incuned by Me deadent prlor to death which nmained unpaid as of tha data o(deaM,ineludfng unrefmbunW madkal expe sn.
ITEM VALU AT DATE
NUMBER DESCRIPTION OF EATH
' ga�r,t e�/fisr.r%ca crtid�f card bake.nc� f/8 .Py
2. .FCtio- rnld -Fnr l�cariruj a�d baft'tr'ies �.Z ,7�'
3. Ho y Sprr�E Hef�,ts! —ba/aNCt clua �! � , so
`f• Camp N:// C'hy�f�r /��-z P f' , o0
5. l�.�c a�w �¢tno ex.r.� Pr� �j �{�i,/i*aw ,�a � �x...� r 3 ..o0
(e. l�l. $. %vYstSkPy �r Qmul�/� •lo!/ f!/ .ao
TOTAL(Also enter on line iD,RecapiWla6on) S j_8Q l7
(I(more spece is needed,inserl aAtliOOnal streets of Me same size)
_ . _ . ._ . _ . _
� REV-1513 E%+(11-OB) - �i
�,.J pennsylvania SCHEDULE J 'I
. �y DEPAHiMENTOiREVENUE
,N„ER,r,wc�T,�REn,RN BENEFICIARIES ,
RESIDENT DECEDEHf � � � I �
ESTATE OF FILE NUN R
Tohn K. Basb a/- �z — o��
RElAT10N5HIP TO DECEDENT AMOUNT R SHARE
NUMBER NAME AND ADDRESS OP PERSON(S)RECEIVING PROPERN Do Not List Tru�tas(s) � OF E ATE
I TAXABLE DISTRIBUTIONS[Indude ouMqht spousal distribu[iwis and t2nsters under �
Sec.2116(a)(1.2).] � �
1� p� �ara'rapl� 1�.1 , Tien(/afo� �f Res�du�
�t 6G �i�.:��c✓ �tn�iA'1sI� YI°i Jfitn.r�i�/d/C
rr
9s j'm/lnws:
A. J�./on Bus�i �r.�ds°n a ks%d�.e
� $. .¢.u�Si� F1HS! �randsmn 2q rcsid�.
6B/tr aF s7z /I�.%/u-hf/r.�
/�Iccl,r�:�sdHr,, .�•� ��oss
C. �S6awr� ,Busfi �ra'edson ��o s%due
�`�3� Rhode Ssland Avenac,N[�lst/o,2
�v,rsl�:r�fi,�, !�C .joo ps
17. �SSirA L"�NSfI �/'4n�a�4� iy� iU�tc�
Jr`/ /f'IRiA S�� /� ,Q
fC'��i�� /J1.�f /o.ZG�3, ���1, ��
EMER DOLLAR AMOUNTS FOR DISTR[uBUT10N�N AB�OV ON lINES IS THROUGH 18 OF REV-I500 COVER SMEE(,AS APPROPIt1ATE.
II NON-TAXABLE DISTRIBUfI0N5:
A. SPOUSAL DISTRIBU710N5 UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
1.
B. CHARRABLE AND GOVERNMENTAI DISTRIBUTIONS � � �
1' T•^in�1� LK/�nrn C�krc� , 200o Chts�hw.t ,Sf
G�airp f/il/, �Ia /yo/I !SO O, o0
� Curt �nt��alio.,�l, .T,,c., 7oi /�as/er /I-ve• •
�c�uoyoc, .d.� /ra�3 ��, o.u�
TOTAL OP PART II- EMER TOTAL NON-TAMABLE DISTRIBMONS ON LINE 13 OF REV-1500 COVER SHEEf. ; 7 DD , eo
If more space is needed,insert additlonal sheets of Me same size.
_ .
I
' 'I
� �, ;SCy��. J ',
� �sr e s�� K_8�ti _____ ._ �����o. 2�=�
--- ___ _ t - -�_. f -- - - _--Lo7_� _ _
__ _ j �_1n� ��s� __ _ _._. . - - -- _ .
' S.�O� �SiR�G�4 Lt� �q:r_Fw_lr��i� ,?_203Z _�r��a�h�'er._. _.rZ _1G�fic�K_e.
_ __ � .__ _ __ __ . _ . _ _... _-- __ _
_ _ I p��D�`� _
_ _ - _ _ _._ _ _. _.
____ _.. _- I___/1L�rk_!f.�3rts�i __ _
_ _ _ _._ _ _
__._- �_s.3�� ���4.._{ll,i..__�ii'�2C�_1�If ��03Z .. .Ssil. _._. .. .30 /f�/d�e _._
. ..___. . _. _..._ i ._._ .. __. __..... .__ __._ _.._. . ...__. ..___ ____.. ..._._ ._.... ___..
__ �L.t. �. tgIL5.�7 _._. "� _ _ _ . . . ..
... .. ..__.
� .�2 �/l�[/'.Cg�i'c�, ��NI�![S�J�'i �/703s. .�`Y7 c30 /CSIC�KG
I
_ � __ y _ _ _ __ _ _ _
�!I_ _��Jlre Ri�'lJ�" _ _- _ _ _ __ _ _
p -- �/
� s�0/ L�IY/l4�� /P��_��rCS�!!/+�� �/70.� kfg� ... �p s Kdidke..
_ I . _.�
- I _ _ __
1 __. _.__ . _ __.. ._ _
___ _ _ _
_ � _
. _ . � _ . ._ .__
__ _ I _ ____ _ _ _ - ._ _ _
_ � _ _ _ _. _ _ _ . . _ _. _ . __.
i
__ I _ _ _ _ _ _ _ _
__. _
� __ . _ _ __ _ _ _
___. _ _ _- _
_ i . - -----. _
__ _ _
i
. � _ _
. _
_ � .
_ _ _ _
_ � _ _ ___ _ ___
_ _ _ _ _
{ __ _ _ _ _ _ _ _
_ _ __ __ .
� _.. _ _._
__. _ _ _ _ _ _
i
_ i _
� _ _ _ _ _ _ . _
___ _ __
i
LAST WILL AND TESTAMENT OF JOHN K.BUSH �I
I,JOHN K.BUSH.av unremaRied�vidowa,currenUy of 3108 Harvard Aven e,Camp Hill,
(,l�mberland County,Pennsylvania,being of somd and disposinB mind,memory and dentianding,
do make,pubGsh and declare this my Last Will and Testament,haeby revoking and aking void
any and all piior Wills azid Codicils by me at eny time heretofore made.
1.
I direct the paymrnt of all my just debts and funeral cxpe°�es as soon after my dccease es
the same can conveniendy be done.
2.
All the rest.residue and remaindu of my Estate,real,personal and mixed,w va �
and wt�oresoevtt siNate,I give,devise,and bequeath to be divided and distributed es ollows:
A: The sum of Five Thous�d(55,000.00)Dollars to t6e Trinity Lut6 Church, �
� cmrently tocated at 2000 Chesmnt Steet,CamP I�ill.Cumberlend Co ty, . .
penaaylvania. Tlus gift sfiatl be only usod for one or more of the follo 'ng
puryoses:Music programs md retatad expa�ses.
B. T6e Sum of Two Thousand(52.000.00)m�ars�°C�ue Intemaaonal, �nc.
cucrenUy Iocaud at 701 Bosler Aveuue,Lemoyne,G�mbaland Coun ,
Pennsylvmia
C. In the event that I tiave herewith enclosed a list of specific bequests,I direct that .
t6e itaos therein listed be disUibuted W the pasons therein listed. fair value
of such items shall be calculated and sha11 be epportiuned eBeinst eac child's
evp�tuel sAare of the residue of my Estate so that ell children shell sh equa0y
in my F.stau.
D. The ranaining residue of my Estau s6e11 be 4ather divided end ' uted es
follows:
1. Teu(lOYo)pacent t6ereof shall be diVided and dis�ibuttA eq y arnonBst
� my mdual grmdchiidren of the wlwle blood(pmluding any s or
� adopted gandehildcen,and elso excluding TIA MARIE R who is
. se}xirately provided for hereinbelow)who survive me. � t .
Pege 1
,i
�
;
remainin balance of the residue shall be further divid II�� and
2. T6e thrn g
distributod in equel shares.as follows:
i. One share[o my so4 MARK A.BUSIi,ver sdroes.
ii. One shere to my son,ERIC C.BUSH,ner stirves.
iii. One share to 17A MAWE K17'NER.ner stirces.the tec of
my now dx.eaced daugMec,KA771Y BUSH.
3.
i nominate,cons6tute end appoint my soq ERIC C.BUSN,cmrently of 572 'lla
Boulevard MxF�anicsburg.G�mberland Counry,Pennsytvenia,to be the Facecutor of 's my
Last Will and Testamrnt In the evrnt that he should predxcase me for any reeson mwilling
or unable to act as such Facxutor,I�rominate,consUtute and appoint my soq MARK .BUSH
curtenUy of 5308 Esabella CourE,Faidex,Fairfax Counry,Virginia,to be ExecuWr in his place
azid steed.-I fivther d'uect that t6ey shali uot be required to file bond or other secnrity the
Office of the Register of Wills for the pmpose of edministering my Estate.
IN///���W��,1�TTiESS WHEREOF,I have haeumo set my hand and seal this /S� day of
� ,A.D:201 l.
�S�)
JO K BUSA
� Signed.sealed,published eod doclered by tlw above-mmed JOHIV K BUS aa and for
Iris Last Will and Testameat,in the Resence of us,who at his requat and in his� .and in
the presenee of eech oihcr,have htte�mto subscribed our names as witnesses•
� � �
LGG
Pege 2
_ _ __
w �"' a
�., � o cL
`, ` N � .
.—� —� O
i:.: : :.i_ :7 V
L�. "� � t7 i� �
.�.- � � '.,��. [n �
. � a am ojoug
c:, !z' [�— �.0 z J
1.:; �•.:. GV 1 '�^{ � �� �.5�.7
G; `_ U �r W
r`, t^ � ��- [2]
�_ t, , Q � n�e-�-ld-,CawouF�
< « �
� �,= "' `� III `SPTa?4S '� Sal�u�
ih��
`smo,i�ijn.q,SaaA
•�auew s�y�oa uoqua�e pui��no�i ao;no,C�ueqs
'£IOZ `bi aunf uo luas P� £I i 'oH aaq�
�in+pred sen��uauz�iEd�ces aousluayuI aq,I, •aa3 ��?I3 a���3 00'Si$3o�unoure a�p ui Z j •oN
xoaq�Ptre al8qoid lsuoncppB zo3 00'S i Z$30 lunoure ac�u► 4I i 'oN�I�a�I� � Tian�se a�e�s usng
•x uqof ay�ao3 um�ag xEZ aov�uayuI ayl3o satdo� Z �uti3 3O3 PasoToua pu3 aseaid �
;SII!�1c13o ialsi8a .zeaQ •
LLOT'Zi'iZ'�I�t
�1�►fi'?I II9�f 3� �els� �aZI
£iOLI dd `a II��
arenbs asno o� j
asnoH;zno� �Uno�pusiia um�
SII?�1A 3o ia si8ag
£i0Z `9Z a�f
£L4L'S6L �LIL) Xtl3 I66I-Z[6l)
60Z0-99L (LIL) HNOHd�'IH.L JIJR H'W 3fJN0�'J
SSOLI dd`'J21f1ESJINdH��I
spnoy�asnot�puv a�puu,�fo aawo�
avox�asnoZ�9
mv�sv�an�uo.zcv
III `SQ'I�IHS '� S�'RI�H�
v W
v
o -,i j
�� O
� N �o =
a E -_„_'� �/� �
y w �o y/ � N
0
� � � T
IL '�y � O � N =
' Z � � r � M �
ti a �� @ N � � M =
�� W ��' E � J Q � O =
��. Q .-��o ^ 7> Vy � =
_ � N �u VM/ N LL z � a =
a Z��a 1.1� � O a = W -
7 �m- °� LL. o F W CL N =
i N � Nm � J =
a � � � � _
0„ y a uI � UQ =
� � � � V � U -
= W � m
� O
� Q � F-
NwZ
� � = a
a ° � N
w
U �c �
� �
�
_
__�
�-- ;-��
_ �
«y
;�.
tz
,
d -��
:,�
��
z;.