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HomeMy WebLinkAbout04-1173PETITION FOR PROBATE & GRANT OF LETTERS Estate of HELEN L. SHEELY a/so known as Soc~lSecudty No. 191-18-4607 , deceased. No. 21-04- To: Register of Wills for the County of Cumberland Commonwealth of Pennsylvania The Petition of the undersigned respectfully represents that: Your Petitioners, who are 18 years of age or older and the Co-Executors named in the Last Will of the above decedent dated November 7, 2003 , and codicils dated none . The Executor named none died . Renunciations for none attached hereto. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his last family or principal residence at 533 West Louther Street, Carlisle, Pennsylvania. Decedent, then 84 years of age, died Medical Center . December 8 ,2004, at Carlisle ~ Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the Will offered for probate; was not the victim of a killing and was never adjudicated incompetent: N/A Decedent at death owned property with estimated values as follows: (if domiciled in PA) All personal property (If not domiciled in PA) Personal property in PA (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania, situated as follows: 533 West Louther Street, Carlisle, Cumberland County, PA $81,000.00 $ $75,000.00 WHEREFORE, Petitioners respectfully requests the probate of the Last Will and Codicil(s) presented herewith and the grant of letters testamentary thereon. Signature(s) and Residence(s) of Petitioner(s): Prudence L. Sheely 533 West Louther Street Carlisle, PA 17013 ,~,-~ :~. ~;~ ~ O ATH OF PERSONAL REPRESENTATIV COMMONWEALTH OF PENNSYLVANIA : : SS COUNTY OF CUMBERLAND : 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 representative of the above decedent, petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed /Y~..~_~_._ _ _ ,,~:"~'~_ ~. before me this ..22nd day of Prudence L. Sheely - ~' December, 2004. ~)J~ (~.,.. '.~.~.~3~- Register -I No. 21-04- Estate of HELEN L. SHEELY , deceased. DECREE OF PROBATE & GRANT OF LETTERS AND NOW, December 22 ,2004, in consideration of the Petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated November 7, 2003 described therein be admitted to probate and filed of record as the Last Will of Helen L. Sheely ; and Letters Testamentary are hereby granted to Prudence L. Sheely FEES Probate, Letters, Etc ........ $ 235.00 Short Certificates(-2- ) .... $. 6.00 Renunciation(s) ........... $ JCP .................... $ 10.00 Other Will Paqes (-2-) .... $. 6.00 TOTAL: .... $.257.00 Filed..I.;N.: g,.~ .-~AOI-~O¢ ........... IRWIN & McKNIGHT - ~ dj Marcus A. McKniqht, III, Esquire (25476) ATTORNEY (Sup. Ct. I.D. No.) 60 West Pomfret St., Carlisle, PA 17013 ADDRESS 717-249-2353 PHONE s to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Registrar. The original certificatc 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 10784366 No. COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH HELEN L. SHEELY ~.Female ~. 191 -- 18 -- 4607 ,. December 8, 2004 i 1/31/1920 Carlisle, Pa 84 --- I-'-~- .... 17'" ......... '~'F~"-"'--' --o.--- -. - ..... ,,~ Clerk I,~, Grocer7 Store [,~ I,,---e'-M2-q---m?-~---l,. Never Married I,, 533 W. Louther Street ~tCarlisle, Pa 17013 Cumberland m.~? ~,..~ .~ Carlisle Ralph Sheely Florence Baker Prudence L. Sheely Dec. 13, 2004 FD-012909-L 533 W. Louther St. Carlisle Pa 17013 St. John's Cemetery Mechanicsburg, Pa 17055 LAST WILL AND TESTAMENT I, HELEN L. SHEELY, of the Borough of Carlisle, Cumberland County, Pennsylvania, being of sound mind, disposing memory and full legal age, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils her e madg ONE. I direct my Executrix to pay all of my debts, cremation and a ativ~ expenses as soon as convenient after my decease. Furthermore, I direct that all state,:.l..l~ritanc~ succession and other death taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all property composing of my gross estate for death tax purposes, whether or not such property passes under this will, shall be paid by the Executrix of my estate. TWO. My Executrix may, at her discretion, compromise claims, borrow money, retain property for such length of time as she may deem proper; lease and sell property for such prices, on such terms, at public or private sales, as she may deem proper; and invest estate property and income without restriction to legal investments unless otherwise provided hereunder. I authorize and empower my Executrix to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefor, in fee simple, as I could do if living. My Executrix is authorized and empowered to engage in any business in which I may be engaged at my death, for such period of time after my death as seems expedient to said Executrix. THREE. I give, devise and bequeath all of my estate wherever situate to my daughter, PRUDENCE L. SHEELY. .FOUR. I nominate and appoint PRUDENCE L. SHEELY to be the Executrix of this my Last Will and Testament. FIVE. No Executrix acting hereunder shall be required to post bond or enter security in this or any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 7th day of November, 2003. HELEN L. SHEELY ~ Signed, sealed, published and declared by the above-named person as and for a Last Will and Testament, in our presence, who at said person's request, in said person's presence and in the presence of each other have hereunto set our names as subscribing witnesses. M~THA L. I~EL k_/ ~ ACKNOWLEDGMENT AND AFFIDAVIT WE, HELEN L. SHEELY, SHARON L. SCHWALM and MARTHA L. NOEL, the testatrix and witnesses respectively, whose names are signed to thc foregoing instrument, being first duly sworn, do hereby declare to thc undersigned authority that the testatrix signed and executed the instrument as her Last Will and that she had signed willingly, and that she executed it as her flee and voluntary act for the purpose herein expressed, and that each of the wimesses, in the presence and hearing of thc testatrix, signed the Will as a witness and that to the best of their knowledge thc testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. .E/L~EN L. SHEELY S.AR p. ~T~- ~L' NOE~.J COMMONWEALTH OF PENNSYLVANIA : : SS: COUNTY OF CUMBERLAND : Subscribed, sworn to and acknowledged before me by HELEN L. SHEELY, the testatrix herein, and subscribed and sworn to before me by SHARON L. SCHWALM and MARTHA L. NOEL, witnesses, this 7th day of November, 2003.,/,~ / Marcu~otaPj Publ~ Carlisle Boro., Cumberland Count~ My Commission Expires Oct, 10,20136 , CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Estate No.: Helen L. Sheel¥ December 8, 2004 21-04-01173 To the Register: I certify that notice of the beneficial interest required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on December 22, 2004. Name Address Prudence L. Sheely 533 W. Louther Street, Carlisle, PA 17013 Notice has now been given to all persons entitled thereto under~ule 5.6(a~cel0t none . Date: 12-22-04 ign~a~re/V~/%I~i~'''~'¢ .~~ IRWIN ~ ~c~~GHT N~ Name ~u~s A. McKnight, III, Esquire \ Address 60 We~ ~ Carlisle, PA 17013 Capacity: Telephone(717) 24%2353 X __ Personal Representative Counsel for Personal Representative l ' NJ ,?,D, ~REV-1500 EX + (6-00) CAPB HpRL EplO CRAC KOTK ES C P o 0 R N R 0 E E S N T C o M P T U A T X A T I o N REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER o E C E D E N T COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME (lAST, FIRST, AND MIDDLE INITIAL) OFFICIAL USE ONLY 21-04-1173 SHEELY HELEN L. OAT~ OF DEATH (MM-DD-YEAR) COUNTY CODE YEAR SOCIAL SECURITY NUMBER 191-18-4607 THIS RETURN MUST BE FIL.ED I" DUPLICATE WITH THE NUMBER REGISTER OF WILLS SaCIA.L SECURITY NUMBER X 1. Original Return 4. limited Estate X 6. Decedent Died Testate 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. D~edent Maintained a Living Trust (Attach copy of Trust) (Attach copy of Wilt) D 9. litigation Proceeds Received 3 (date of death . RemaInder Return prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 010. Spousal Poverty Credit 0 11. Election to tax under Sec. 9113(A) (date of death between 12:-31v91 and 1-1-95) (Attach Sch O) . THIS SECTION MUST BE.l:oMPLETED. ALL CORRESPONDENCI: & CONFIDENTIAL tAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPL.ETE MAILING ADDRESS Marcus A. McKni ht FIRM NAME (It Applicable) 60 West Pomfret Street West Pomfret Professional Bldg. Carlisle, PA 17013 IRWIN & McKNIGHT TELEPHONE NUMBER R E C A P I T U L A T I o N 17 249-2353 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule Gar L) 8. Total Gross Assets (total lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (1) (2) (3) 88,000.00 None None (4) (5) None 84,725.46 (6) 31,496.10 None 21,255.51 None SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(aX1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. . .. CHECK HEllEIF.vOUAllUtlli9t.!E$TING A FlE!1t.!ND'Ol'p,! OVlIi > > BE SURE ro ANSWER ALL QUESTIONS ON REVERSE OFFIC!~t, USE ONLY , (, I,,' (8) 204,221.56 (11) 21. 255.51 (12) 182,966.05 (13) (14) 182,966.05 0.00 X .0 0 [15) 0.00 182,966.05 X .045 (16) 8,233.47 0.00 X .12 (17) 0.00 0.00 X .15 (18) 0.00 (19) 8,233.47 Copyright tc) 2000 torm software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) T r Decedent's Complete Address: STREET ADDRESS 533 W. Louther Street CITY I STATE I ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditsIPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 8,233.47 0.00 411.67 Total Credits ( A + B + C) (2) 411.67 3. Interest/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) A. Enter the interest on the tax due. (SA) B. Enter the total of Line S + SA. This is the BALANCE DUE. (5B) Make Check Payable 10: .. ...... F1E.c;'l)TE:F1 ()F WI~LS,AGENT . ,.......Fn::::iiH1Hi;ii:!i;;":,,;"" "",.,:"i;!:ii:i!ii:i!i!ii!i!;i! ;:i;i;:'ii:HHiiIHi;iliij':"""""'--' '-"""".:,;,:";i,"1:';"";""""";,;,';':";;:'":"i:';;i';;"",',i',',j'i!':"':!'i"','''',;'i!",n,i,;:,'''''i'1;;';;i;;'''',,;',,;;,,:;'':i'[i''';;',:ni1:i:,:';!;",;;":";,;';;o'i'i""",:"'''';;';'::'"'",;', ,;,,,@i,,,';';""";:;i:";i;,iii'iii"ii'i,'i,H,;;';1i,,,;'i1::':;::1;;";:';'::,j'i'i';,i'1ii"i":i:":;';;ji'ii::i',"i'1' PLEASE ANSWER. THE FOliOWING QUESTIONS BY PLACING AN "X'; IN THE APPROPRiATE BLOCKS 1. 0.00 0.00 7 ,821. 80 0.00 7 ,821.80 Did decedent make a transfer and: a. retain the use or income of the property transferred; b. retain the right to designate who shall use the property transferred or its income; . c. retain a reversionary interest; or. . d. receive the promise tor life of either payments, benefits or care? 2. If death occurred atter December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? . 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Yes No ~~ o o o IT] IT] IT] Under penalties of perJury, I declare that f have examined this return, Including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all Information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN Prudence L. Sheely 533 W. Louther St. ----------------------------------------------------- Carlisle PA 17013 IRW1N & McKN1GHT 60 West Pomfret Street - - Carl-{si;'- - - 1>A- - - i i6i3 - - - - - - - - - - - - - - - - - - - - - - - - - -- DATE d- J& 0'-) DATE For dates of death on or atter January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the onry beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S, 9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to orfor the use of the decedent's lineal beneficiaries is 4.5"10, except as noted in 72 P.S. 9116(1.2) [72 P.S. 9116(a)(11]. 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. 9116(aX1.3)]. A sibling is defined, under Section 9102. as an individual who has at least one parent in common with the decedent, whether by brood or adoption. Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) R~-1502 EX +(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER HELEN L. SHEELY SS# 191-18-4607 12/08/2004 21-04-1173 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seifer, neither being compelled to buy or sell, both having reasonable knowledqe of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Sc:hedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 533 W. Louther Street, Carlisle, PA 88,000.00 Appraisal Attached. SCHEDULE A REAL ESTATE TOTAL (Also enter on line 1, Recapitulation) $ 88,000.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form softw<1re only CPSystems, Inc. Form REV-1502 EX (Rev. 1-97) RIfV-150B EX + (1-97) COMMONWEALTH OF PENNSYLVA.NIA. INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF HELEN L. SHEELY SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY SSlf 191-18-4607 12/08/2004 FILE NUMBER 21- 04 -1173 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1 DESCRIPTION VALUE AT DATE OF DEATH 840.00 Travelers Checks 2 M&T Bank Savings Account - 25004920036173 200.03 3 M&T Bank Checking Account - 436798 51,704.89 4 Waypoint Bank - Savings Account - 1700000337 30,966.54 5 Personal Property 1,014.00 TOTAL (Also enter on line 5, Recapitulation) $ 84,725.46 (If more space is needed, insert additional sheets of the same size) Copyright (el 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97) R~V-1509 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF HELEN L. SHEELY SCHEDULE F JOINTL V-OWNED PROPERTY SSiF 191-18-4607 12/08/2004 FILE NUMBER 21-04-1173 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. A. SURVIVING JOINT TENANT(S) NAME Prudence L. Sheely ADDRESS 533 W. Louther St. Carlisle, PA 17013 RELATIONSHIP TO DECEDENT Daughter B. c. JOINTLY-OWNED PROPERTY, LEITER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial Institution and bank DATE OF DEATH DECO'S VALUE OF account number or similar identifying number. NUMBER TENANT JOINT Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1 M&T Bank - Certificate of 27,189.38 50.00% 13,594.69 Depos it - 31003910198413 2 M&T Bank - Savings Account 35,802.82 50.00% 17,901.41 - 15004201315048 TOTAL (Also enter on line 6, Recapitulation) $ 31,496.10 (If more space is needed insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1509 EX (Rev. 1-97) R~V-1511 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF HELEN L. SHEELY SSlf 191-18-4607 12/08/2004 FILE NUMBER 21-04-1173 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES, 1 Ronan Funeral Home 6,846.00 B. ADMINISTRATIVE COSTS, 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number{s) / EIN Number of Personal RepresentattlJe(s) Street Address City State Zip - Year(s) Commission Paid: 2. Attorney's Fees IRWIN & McKNIGHT 9,875.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3,500.00 Claimant Prudence L. Sheely Street Address 533 W. Louther St. City Carlisle State PA Zip 17013 Relationship of Claimant to Decedent Daughter 4. Probate Fees Register of Wills 257.00 5. Accountant's Fees 6. Tax Return Pre parer's Fees 250.00 7. Other Administrative Costs 1 Cumberland Law Journal - Estate Notice 75.00 2 Larry Foote - Appraisal 275.00 3 Roy D. Gottshall - Appraisal on Personal Property 55.00 4 The Sentinel - Estate Notice 122.51 TOTAL (Also enter on line 9, Recapitulation) $ 21,255.51 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97) RFV-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCETIO<. RETURN RESIDENT OECEDEN"T SCHEDULE J BENEFICIARIES ESTATE OF HELEN L. SHEELY SSlf 191-18-4607 12/08/2004 FILE NUMBER 21-04-1173 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE 1 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distrlbutfons. and transfers under Sec. 9116(aX1.l)j Prudence L. Sheely 533 W. Louther Street Carlisle, PA 17013 Daughter Remainder NUMBER I. ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18. AS APPROPRIATE. ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS, A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- 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) Copyright (cl 2000 form software only "The Lackner Group, Inc. 0.00 Form REV-1513 EX (Rev. 9-00) LAST WILL AND TESTAMENT I, HELEN L. SHEELY, of the Borough of Carlisle, Cumberland County, Pennsylvania, being of sound mind, disposing memory and full legal age, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking aU Wills and Codicils heretofore made by me. ONE. I direct my Executrix to pay all of my debts, cremation and administrative expenses as soon as convenient after my decease. Furthermore, I direct that all state, inheritance, succession and other death taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all property composing of my gross estate for death tax purposes, whether or not such property passes under this will, shall be paid by the Executrix of my estate. TWO. My Executrix may, at her discretion, compromise claims, borrow money, retain property for such length of time as she may deem proper; lease and sell property for such prices, on such terms, at public or private sales, as she may deem proper; and invest estate property and income without restriction to legal investments unless otherwise provided hereunder. I authorize and empower my Executrix to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds andlor bills of sale therefor, in fee simple, as I could do if living. My Executrix is authorized and empowered to engage in any business in which I may be engaged at my death, for such period of time after my death as seems expedient to said Executrix. THREE. I give, devise and bequeath all of my estate wherever situate to my daughter, PRUDENCE L. SHEELY. FOUR. I nominate and appoint PRUDENCE L. SHEELY to be the Executrix of this my Last Will and Testament. FIVE. No Executrix acting hereunder shall be required to post bond or enter security in this or any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 7th day of November, 2003. U~~ (~ AL) HELEN L. SHEEL Y Signed, sealed, published and declared by the above-named person as and for a Last Will and Testament, in our presence, who at said person's request, in said person's presence and in the presence of each other have hereunto set our names as subscribing witnesses. ~;"'./""~fY"~f!,~ SHARON L. ~HW ALM ACKNOWLEDGMENT AND AFFIDAVIT WE, HELEN L. SHEELY, SHARON L. SCHWALM and MARTHA L. NOEL, the testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her Last Will and that she had signed willingly, and that she executed it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the Will as a witness and that to the best of their knowledge the testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. ~. ~(~(i2r rELEN L. SHEELY \V~~ /: .04.Jd.F'.-- SHAR~nljA~1j( tW ~ COMMONWEALTH OF PENNSYL VANIA : SS: COUNTY OF CUMBERLAND Subscribed, sworn to and acknowledged before me by HELEN L. SHEELY, the testatrix herein, and subscribed and sworn to before me by SHARON L. SCHWALM and MARTHA L. NOEL, witnesses, this 7th day of November, 2003 .......~_____ Notarial Seal MarcuSll::-MeKfligl9t;ltI;"J'Jotary PtJIlfIC Carlisle Bore., Cumberland County My Commission Expires Oct. 10. 2005 Memoo.. ,.'to"" ':':; ,,'ivania Associatioo Of Nolanes APPRAISAL REPORT 533 WEST LOUTHER STREET CARLISLE, PENNSYL VANIA PREPARED FOR THE ESTATE OF HELEN L. SHEELY BY LARRY E. FOOTE DIVERSIFIED APPRAISAL SERVICES 35 EAST HIGH STREET, SUITE 101 CARLISLE, PENNSYL VANIA 17013-3052 (717) 249-2758 SUMMARY OF IMPORTANT FACTS AND CONCLUSIONS LOCATION: 533 West Louther Street Carlisle, Pennsylvania TAX PARCEL NUMBER: 05-20-1796-165 IMPROVEMENTS: Two-story semi-attached single-family dwelling. PROPERTY RIGHTS: Fee simple interest. OWNERSHIP HISTORY: The subject property is owned by Helen L. Sheely. No sale of the property has taken place within the past three years. SCOPE OF THE ASSIGNMENT: The scope of the assigmnent included an analysis of the subject's area, an inspection of the subject property, an estimation of the property's highest and best use, consideration of all three approaches to value, and the application of those relevant to the valuation of the subject. OBJECTIVE: To estimate the market value of the subject property as unencumbered. EFFECTIVE DATE: December 8, 2004. HIGHEST AND BEST USE: Continued use as a single-family residence. COST APPROACH: N.A. SALES APPROACH: $88,000 INCOME APPROACH: N.A. FINAL VALUE CONCLUSION: $88,000 2 APPRAISAL CERTIFICATION I hereby certifY that upon application for valuation by: THE ESTATE OF HELEN 1. SHEELY the undersigned personally inspected the following described property: All that certain piece or parcel of land, with the improvements thereon erected, situate in the Fourth Ward of the Borough of Carlisle, Cumberland County, Pennsylvania, bounded and described as follows: On the South by West Louther Street; on the West by land now or foanerly of Goodyear Shoe Company; on the North by an alley 12 feet wide; and on the East by land now or formerly of Hulda McCoy, containing 22 feet, more or less, in front on West Louther Street and extending at an even width a depth of 107 feet 9 inches to the alley in the rear and being improved with a two-stOl)' frame dwelling house known as No. 533 West Louther Street. To the best of my knowledge and belief the statements contained in this report are true and correct, and that neither the employment to make this appraisal nor the compensation is contingent upon the value reported, and that in my opinion the Market Value as of December 8, 2004 is: EIGHTY-EIGHT THOUSAND DOLLARS $88,000 The property was appraised as a whole, subject to the contingent and limiting conditions outlined herein. ;7 / k'" w~,::;--::J~ , ,,",.</v.~v- Larry E. Foote Certified General Appraiser GA-000014-L 3 PURPOSE OF THE APPRAISAL The purpose of this appraisal is to estimate the Market Value of the subject property as of December 8, 2004. Market Value, as defined by the courts, is the most probable price estimated in terms of money which a property will bring if exposed for sale in the open market, allowing a reasonable time fmding a purchaser who buys with knowledge of all the uses to which it is adapted and for which it is capable of being used. Frequently, it is referred to as the price at which a willing seller would sell and a willing buyer would buy, neither being under abnormal pressure. HIGHEST AND BEST USE Highest and Best Use is defined by the Appraisal Terminology and Handbook, published by the Appraisal Institute, as "the most profitable likely use to which a property can be put". The opinion of such use may be based on the highest and most profitable continuous use to which the property is adapted and needed, or likely to be in demand, in the reasonable near future. However, elements affecting value that depend upon events or a combination of occurrences which, while within the realm of possibility, are not fairly shown to be reasonably probable, should be excluded from consideration. Also, if the intended use is dependent on an uncertain act of another person, the intention cannot be considered. Based on the above defmition and after seeing the site, neighborhood, and area, it is my opinion that the present use of the subject is its Highest and Best Use. 4 SITE DATA ADDRESS: 533 West Louther Street BOROUGH: Carlisle COUNTY: Cumberland STATE: Pennsylvania LOT SIZE: 22' x 107.75' SEWERS: Public utility. WATER: Public utility. ELECTRICITY: PP&L LANDSCAPING: Typical for the area, with a sodded lawn, trees and shrubs. DETRIMENTAL INFLUENCES None. Pride of ownership is evident throughout the neighborhood. DESCRIPTION OF IMPROVEMENTS GENERAL DESCRIPTION: Two-story semi-attached single-family dwelling containing approximately 1,520 square feet of gross living area above grade. CONDITION: Exterior: Average Interior: Average to good. ROOMS: First Floor: Living room, dining room, kitchen and one-half bathroom. Second Floor: Three bedrooms and a full bathroom. Basement: Full, with partial concrete floor. EXTERIOR: Foundation: Walls: Sash: Gutters: Roof: Stone Aluminum siding. Wood-framed, double-hung. Aluminum and steel, painted. Asphalt shingles. 5 INTERIOR, PRINCIPAL ROOMS: Flooring: Walls: Ceilings: Trim: KITCHEN: Cabinets: Counters: Walls: Flooring: Sink: BATHROOM: Carpet and yellow pine. Plaster and paneling. Plaster, drywall and acoustical tile. Wood, painted. Knotty pine, natural finish. Formica Plaster, painted. Vinyl Double-bowl, porcelain. Flooring: Vinyl Walls: Drywall, painted. Bathtub: Built-in, with shower. Lavatory: Vanity Water closet: Two-piece. Medicine cabinet: Wall-mounted. CONSTRUCTION: Joists: Beams: Columns: Plumbing: HEATING: Wood Wood Wood Copper and iron. Gas-fired, forced hot air. HOT WATER: Gas-fired, 30-gallon. ELECTRIC: Circuit breaker system, I DO-ampere. OTHER: Attached to the front of the dwelling is a covered porch, and attached to the rear ofthe dwelling is a wraparound enclosed porch and a second floor balcony. GENERAL CONDITION: All improvements are considered to be in average to good condition on the interior and average condition on the exterior, with mechanical systems appearing to be adequate and functioning properly. 6 THE APPRAISAL PROCESS Three approaches to value are generally included in an appraisal report. These techniques include the cost approach, sales comparison approach, and income approach to value. The cost approach to value is based on the assumption that the reproduction cost of a building plus land value, tends to set the upper limit to value. A key assumption is that a newly constructed building would have advantages over the existing building, therefore an evaluation focuses upon disadvantages or deficiencies (depreciation) of the existing building compared to a new facility. Due to the age of the subject improvements, the cost approach is considered to be inappropriate and has, therefore, not been included in the development of this appraisal report. The sales comparison approach to value assumes that under normal conditions, a given number of parties acting intelligently and voluntarily, tend to set a pattern from which value can be estimated. Application of this approach relies on a comparison of the subject with a sufficient number of recent transactions of comparable properties in the market, based on a common unit, such as price per square foot of building area. The income approach concerns itself with present worth of the future potential benefits of a property. The initial estimate involves the net income, which a fully informed person is justified in assuming the property will produce during its remaining useful life. This estimated net income is then capitalized into a value estimate, based upon the level of risk as compared with that of a similar type and class. Since homes similar to the subject are not typically utilized as income-producing investment properties, the income approach to value is considered to be inappropriate and has, therefore, not been included in the development of this appraisal report.+ 7 SALES COMPARISON APPROACH In arriving at this conclusion of the value of the subject property, the appraiser made a survey of properties that have sold in the area of the subject property. Consideration was given and adjustments were made on each comparable sale as to time of sale, size, location, as well as all other factors that might affect value. A resume of some of the sales considered by the appraiser is as follows: SALE NO. I: Location: Date of Sale: Sale Price: Size: Unit Price: SALE NO.2: Location: Date of Sale: Sale Price: Size: Unit Price: SALE NO.3: Location: Date of Sale: Sale Price: Size: Unit Price: 536 West Louther Street, Carlisle. October 17,2002. $72,500 1,188 square feet. $61.03 per square foot. 574 West Louther Street, Carlisle. May 28, 2004. $83,500 1,302 square feet. $64.13 per square foot. 534 West Louther Street, Carlisle. November 13, 2002. $70,000 1 , 18 8 square feet. $58.92 per square foot. The appraiser, in addition to the sales listed, also considered several additional sales in arriving at his final opinion of value. On the Sales Comparison Analysis form that follows this page are dollar adjustments reflecting market reaction to those items of significant variation between the subject and comparable properties. If a significant item in the comparable property is superior to, or more favorable than, the subject property, a minus (-) adjustment is made, thus reducing the indicated value of the subject; if a 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 the subject. After making all of the necessary adjustments, it is the appraiser's considered opinion that the indicated value of the subject property by the Sales Comparison Approach is $88,000. 8 SALES COMPARISON ANALYSIS ITEM SUBJECT COMPARABLE #1 COMPARABLE #2 COMPARABLE #3 533 W. Louther St. 536 West Louther Street 574 West Louther Street 534 West Louther Street Address Carlisle Carlisle Carlisle Carlisle "~""-.,~~ Sale Price N.A. $72,500' .... $83,500 $70,000 Price / Sq. Ft. GLA N.A. $61.03 \" $64.13 " $58.92 Data Source tnspection Courthouse records Courthouse & Central Penn MLS Courthouse records ADJUSTMENTS DESCRIPTION DESCRIPTION $ Adjust. DESCRIPTION $ Adjust. DESCRIPTION $ Adjust. Sales or Financing Concessions None None None Date of Sale I Time As of 12-8-04 ]0-]7-02 +7,300 5-28-04 ]]-13-02 +7,000 Location Average Similar Similar Similar Site J View 22' x 108' 17'x107' ]9' x 120' 17' x 105' Design and Appeal Two~story seirn-an. Two-story attached +2,000 Similar Two-story attached +2,000 Construction Aluminum siding Brick -5,000 Brick -5,000 Brick -5,000 Age 96 years 112 years 104 years 102 years Condition Average to good Similar Similar Similar Above Grade Tot. Bed. Bath Tot. Bed. Bath Tot. Bed. Bath Tot, Bed. Bath Room Count 6 3 l~ 5 3 ] +3,000 5 2 1 +3,000 5 3 1 +3,000 Gross Living Area 1,520 square feet 1,188 square feet +]0,000 1,302 square feet -1-6,500 1,188 square feet +10,000 Basement &Finished Rooms Below Grade full basement Similar Similar Similar Functional UtifuV A vera;e Similar Similar Similar Heatin" f Coolin':"- Gas~fired FHA Similar Similar Similar Garaoe I CllMVlrt None None None None Porches, Patios Porch, eocl. porch, Two porches, Two porches, Two porches, Pools, etc. baleon". balconv. +500 balconv. +500 balconv. +500 Special Energy Typical for the Efficient Items re-';;on. Similar Similar Similar Firenlace{ s \ None None None None Other (e.g. kitchen equip., remodeling) Built~ins. Similar Similar Similar Net Adj, toral\ ., +17,800 . +5,000 -1-]7,500 Indicated Value ofSubiect ,...' 90,300 .,' , 88,500 87,500 FINAL INDICA TED VALUE OF SUBJECT PROPERTY: $88,000 9 CORRELATION Correlation may be defined as "tbe bringing together of parts in a proper relationship." The parts ofthis appraisal report are tbe following approaches to value your appraiser used: Value Indicated by Cost Approach Value Indicated by Sales Comparison Approach Value Indicated by Income Approach N.A. $88,000 N.A. These approaches are representative oftbe market value of the subject property. I have carefully reexamined each step in each method, and I believe the conclusions accurately reflect the attitude of typical purchasers of this type property in tbis neighborhood. It is my belief that tbis reexamination has confirmed the original conclusions. The Cost Approach will result in an excellent estimate if all elements are figured accurately, because no prudent person will pay more for a property than the cost to produce a substitute property with equal desirability and utility. Purchasers of the type of dwelling typical of tbe subject property are more concerned with amenities than with hypotbetical replacement of the property. Due to the age oftbe subject improvements, the Cost Approach is considered to be inappropriate and has not been included in this appraisal report. The Sales Comparison Approach was based on several recent sales of properties similar to that of tbe subject, all of which are located in the same general area. The adjusted sales prices are most consistent under comparison. This approach is tbe most reliable because it reflects the reactions of typical buyers and sellers in the market. The Income Approach is most applicable to income producing properties or properties that are primarily utilized for income producing purposes. Purchasers of income producing properties are willing to pay no more for a particular property than the net operating income will support. Since tbe majority of properties similar to the subject are not utilized for income producing purposes, this approach to value has not been included in this appraisal report. Therefore, as a result of this appraisal and analysis, it is this appraiser's considered judgment and opinion that the Market Value of the subject property, as of December 8, 2004, IS: EIGHTY -EIGHT THOUSAND DOLLARS $88,000 10 UNDERLYING ASSUMPTIONS AND LIMITING CONDITIONS SUBJECT TO THIS APPRAISAL I. I assume no responsibility for matters legal in nature, nor do I render any opinion as to the title, which is assumed to be marketable. The property is appraised as though under responsible ownership. 2. The legal description used herein is correct. 3. I have made no survey of the property, and the boundaries are taken from records believed to be reliable. 4. I assume that there are no hidden or unapparent conditions of the property, subsoil or structures which would render it more or less valuable. I assume no responsibility for such conditions or for engineering which might be required to discover such factors. 5. The information, estimates, and opinions furnished to me and contained in this report were obtained from sources considered reliable and believed to be true and correct. However, no responsibility for accuracy can be assumed by me. 6. This report is to be used in its entirety and only for the purpose for which it was rendered. 7. Neither all nor any part of the contents of this report (especially any conclusions as to value, the identity of the appraiser or the fIrm with which he is connected) shall be reproduced, published, or disseminated to the public through advertising media, public relations media, news media, sales media, or any other public means of communication, without the prior written consent and approval of the appraiser. 8. This appraisal was prepared for the exclusive use of the client identifIed in this appraisal report. The information and opinions contained in this appraisal set forth the appraiser's best judgment in light of the information available at the time of the preparation of this report. Any use of this appraisal by any other person or entity, or any reliance or decisions based on this appraisal are the sole responsibility and at the sole risk of the third party. The appraiser accepts no responsibility for damages suffered by any third party as a result ofreliance on or decisions made or actions taken based on this report. II CERTIFICATE OF APPRAISAL Your appraiser hereby certifies that: I. The statements of fact contained in this report are true and correct. 2. 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. 3. I have no present of prospective interest in the property that is the subject of this report, and no personal interest with respect to the parties involved. 4. I have no bias with respect to the property that is the subject of this report or to the parties involved with this assignment. 5. My engagement in this assignment was not contingent upon developing or reporting predetermined results. 6. 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. 7. To the best of my knowledge and belief, the statements of fact contained in this appraisal report, upon which the analyses, opinions, and conclusions expressed herein are based, are true and correct. 8. This appraisal report sets forth all of the limiting conditions (imposed by the terms of my assignment or by the undersigned) affecting the analyses, opinions, and conclusions contained in this report. 9. This appraisal report has been made in conformity with the Uniform Standards of Professional Appraisal Practice adopted by the Appraisal Standards Board of the Appraisal Foundation, and is subject to the requirements of the Code of Professional Ethics and Standards of Professional Conduct of the National Association of Realtors Appraisal Section. 12 10. No one other than the undersigned prepared the analyses, conclusions, and opinions concerning real estate that are set forth in this appraisal report. ~z:'h~ Larry E. Foote Certified General Appraiser GA-OOOOI4-L 13 PRIVACY NOTICE Pursuant to the Gramm-Leach-BilIey Act of 1999, effective July I, 200 I, appraisers, along with all providers of personal financial services are now required by federal law to inform their clients of the policies of the firm with regard to the privacy of client nonpublic personal information. As professionals, we understand that your privacy is very important to you and are pleased to provide you with this information. In the course of performing appraisals, we may collect what is known as "nonpublic personal information" about you. This information is used to facilitate the services that we provide to you and may include the information provided to us by you directly or received by us from others with your authorization. We do not disclose any nonpublic personal information obtained in the course of our engagement with our clients to nonaffiliated third parties, except as necessary or as required by law. By way of example, a necessary disclosure would be to our independent contractors, and in certain situations, to unrelated third party consultants who need to know that information to assist us in providing appraisal services to you. All of our independent contractors and any third party consultants we engage are informed that any information they see as part of an appraisal assignment is to be maintained in strict confidence within the firm. A disclosure required by law would be a disclosure by us that is ordered by a court of competent jurisdiction with regard to a legal action to which you are a party. We will retain records relating to professional services that we have provided to you for a reasonable time so that we are better able to assist you with your needs. In order to protect your nonpublic personal information from unauthorized access by third parties, we maintain physical, electronic and procedural safeguards that comply with our professional standards to insure the security and integrity of your information. 14 LARRY E. FOOTE REAL EST ATE APPRAISER EXPERIENCE: 1979.Present: Chief Appraiser, Diversified Appraisal Services, Carlisle, Pa. Principal Broker, LaRue Development Company, Carlisle, Pa. 1976-1979: Associate Broker, Colonial Realty, Carlisle, Pa. 1972-1976: Realtor Associate, Jack Gaughen Realtor, Carlisle, Pa. Appraisal experience included undeveloped land, farms, building lots, single. family dwellings, mobile home parks, medical centers, nursing homes, motels, apartment buildings and complexes, office buildings, service stations, veterinary clinics, rehabilitation centers, retail buildings, daycare centers, warehouses, and manufacturing facilities. EDUCATION: Bachelor of Business Administration, Pennsylvania State University, 1976. Associate Bachelor of Business Administration, Harrisburg Area Community College, 1974. Diploma, Carlisle Senior High School, 1965. Certificate, Pennsylvania Realtors Institute, GRI I, GRI II, GRI III. Certificate, Realtors National Marketing Institute, CI 101, CI 102, CI 103, CI 104, CII05. Standards of Professional Practice, American Institute of Real Estate Appraisers. Real Estate Appraisal Principles, American Institute of Real Estate Appraisers. Residential Valuation, American Institute of Real Estate Appraisers. Appraisal Procedures, Appraisal Institute. Principles ofIncome Property Appraising, Appraisal Institute. Case Studies in Real Estate Valuation, Appraisal Institute. Report Writing and Valuation Analysis, Appraisal Institute. PROFESSIONAL LICENSES: General Appraiser #GA-OOOO I 4-L, Commonwealth of Pennsylvania. Real Estate Broker #RB-029729-A, Commonwealth of Pennsylvania. PROFESSIONAL DESIGNATIONS: GRI: Graduate of the Pennsylvania Realtors Institute, awarded by the Pennsyl- vania Association of Realtors. CRS: Certified Residential Specialist, awarded by the Realtors National Market- ing Institute of the National Association of Realtors. CCIM: Certified Commercial Investment Member, awarded by the Realtors National Marketing Institute of the National Association of Realtors. PROFESSIONAL ORGANIZATION AFFILIATIONS: National Association of Realtors Appraisal Section. Carlisle Association of Realtors. Pennsylvania Association of Realtors. National Association of Realtors. Realtors National Marketing Institute. 15 PAST CLIENTS: Borough of Carlisle Keystone Financial Mortgage Cornerstone Federal Credit Union Pennsylvania State Bank Commerce Bank Cumberland-perry Association for Retarded Citizens Carlisle Suburban Authority Members I" Federal Credit Union Pennsylvania National Bank Evans Financial Corporation Greenawalt & Company, CPA Smith's Transfer Corporation Carlisle Department of Parks and Recreation Executive Relocation Services Carlisle Area School District Messiah Homes, Incorporated ERA Eastern Regional Services Pennsylvania Turnpike Commission Chase Home Mortgage Corporation Defense Activities Federal Credit Union Pennsylvania State Employees Credit Union PNC Mortgage Corporation F&M Trust Company National City Mortgage Corporation Washington Mutual Home Loans, Inc. Prudential Relocation Services Lender's Choice Market Intelligence, Incorporated United Telephone Employees Federal Credit Union Cumberland County Commissioners Allstate Enterprises Mortgage Corporation Dickinson College PPG Industries, Incorporated Gettysburg College Redevelopment Authority of Cumberland County Record Data Appraisal Services, Incorporated First United Federal Savings Association Fulton Bank United States Marshall Service GMAC Mortgage Corporation Orrstown Bank Letterkenny Federal Credit Union BancPlus Mortgage Corporation Coldwell Banker Relocation Services, Incorporated Central Pennsylvania Savings Bank Mellon Bank Provident Home Mortgage Corporation Drovers Bank 16 American Home Bank Trans Union M&T Mortgage Corporation Cody Financial Mortgage Services Waypoint Bank Northwest Savings Bank Blue Ball National Bank Adams County National Bank Countrywide Home Loans Aarrow Mortgage Various law firms and individuals ~- ~'--'- ~-'" ,- ~- ~-~-- .,~;:->'" -- _:L.- , - r: I -~ Ii r:" . .~~- PHOTOGRAPHS OF THE SUBJECT IMPROVEMENTS 17 CONIP ~Ri\BLE S~LE NO. 1 CONIPA1l^BLE S~LE NO. :1 18 I! M&fBank 499 Mitchell Street, MiIlsboro, DE 19966 January 3, 2005 ~,' \'\ r; --. ~ffi Cr.. i r)J.. (r) "r.. 11 '::1" \ r I '" ' ", !', : -, , i .'.L. i~', ,}1 J j. 1=-:1' !t:""~?~ ,,,,,,,~ "-'> '0, h.r..~" \ "-, ".,J '0,/:1' " ,.'\" ~,., ..~.., J.~ -~. .' Law Offices Irwin & McKnight West Pomfret Professional Building 60 West Pomfret Street Carlisle, PA 17013-3222 RE: Estate of Helen L. Sheely Date of Death: December 8, 2004 Social Security Number: 191-18-4607 Dear Mr. McKnight: In response to your request, please be advised tbat at tbe time of deatb, tbe above- named decedent had on deposit witb tbis bank tbe following accounts. L Account Type........................... Certificate of Deposit Account Number........ ............... 31003910198413 Ownership (Names of}.............. Helen L Sheely, Prudence L Sheely Opening Date................... ........11/23/98 Balance on Date ofDeath..........$27, 162.86 Accrued Interest $ 26.52 Total............................. ..... .....$27,189.38 2. Account Type........................... Savings Account Account Number....................... 25004920036173 Ownership (Names of}.............. Helen Sheely Opening Date...........................ll/07 /83 Balance on Date ofDeath..........$200.00 Accrued Interest $ 0.03 Total...................................... .$200.03 . Page 2 January 3, 2005 3. Account Type........................... Checking Account Account Number....................... 436798 Ownership (Names of}.............. Helen L. Sheely Opening Date................... ....... .09/0 1/67 Balance on Date ofDeath.........$51,704.89 Accrued Interest $ 0.00 Total.... ............................... ....$51, 704.89 4. Account Type........................... Savings Account Account Number........... ............ 15004201315048 Ownership (Names of}........... ... Helen L. Sheely, Prudence L. Sheely Opening Date........... ................11/25/98 Balance on Date ofDeath.........$35,790.07 Accrued Interest $ 12.75 Total................................... ....$35,802.82 The above named decedent did not have a safe deposit box with this bank. For any additional information on this account please contact our Stonehedge office at 717-240-4524. Sincerely, 'A / / -;>, ., I ({leV. 71L ''-'" ' , Charlene Warrington, Records Management 1-888-502-4349 =--/ J)i.." /' ~(JI'.'tr;, ,. i..{../':..c l- "..... ,7- ',-- -:/ l"l WaYR.qi!lt 12/24/2004 IRWIN & MCKNIGHT 60 W POMFRET ST CARLISLE PA 17013-3222 ID.'} r~I~. [fi:~\W 15'.' if:! ~i l;.l ~--, Q~:J ~ Lill 2\ {) ,) (i (\ ,~, " ,"' '- J.-J ".~ The information which you requested on the account(s) of HELEN L SHEELY (Social Security Number 191-18-4607) is/are as follows: Account Number Class of Accouot 1700000337 SAVINGS 010171 30964.85 1.69 30966.54 Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership SOLE Name of Joint Owner, if any Date Ownership Was Established 010171 Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of Joint Owner, if any Date Ownership Was Established Additional Information Requested ~~tt[r(/fl ERIN E WATT~ SENIOR SERVICES REP. P.O. Box 1711, HARRISBURG. PENNSYLVANIA 17105-1711 T_II ~-__ . CJcc lA/..""...........-r II ace:: 0=-0 ""7c....C\ . I.., V........" 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I ' Y!0y-.. .... ...~~22-<!.jf/?bU/-z.. ,d,' ~," ,/ ,I I 00\"\'~ -" J7-/ /0/ c.J,5- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128.0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT MCKNIGHT MARCUS A III 60 W POMFRET STREET CARLISLE, PA 17013 n______ fold ESTATE INFORMATION: SSN: 191-18-4607 FILE NUMBER: 2104-1173 DECEDENT NAME: SHEELY HELEN L DATE OF PAYMENT: 02/16/2005 POSTMARK DATE: 02116/2005 COUNTY: CUMBERLAND DATE OF DEATH: 12/08/2004 NO. CD 004959 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $7,821.80 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 021842 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $7,821.80 GLENDA FARNER STRASBAUGH REGISTER OF WILLS COMMONWEAL TH OF PENNSYL VANIA : S8 COUNTY OF CUMBERLAND Prudence L. Sheely , being duly sworn according to law, deposes and says that she is the Executrix of the Estate of Helen L. Sheel v , late of Carlisle Borough Cumberland County, Pennsylvania, deceased and that the within is an inventory made by Prudence L. Sheelv the said Executrix of the entire estate of said decedent, consisting of all the personal property and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value as of the date of decedent's death. Sworn and subscribed before me, i1.1(;1\...- this --1lI1.--- day of February, 2005. ~,.:<<~ /' ~.o/ Prudence L. Sheely, Executrrix 533 W. Louther Street Carlisle. PA 17013 Address Notanal sell \ Karen S ~I/oel, Nnrary Public Carlisle Boro Cumberland County My Commission Expires Dec. 8, 2007 Date of Death 08 Day 12 Month 2004 Year ,..-..,1 INSTRUCTIONS 1. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheels may be attached as to personalty or realty. 4. See Article IV, Fiduciaries Act of 1949. -ci " ~ '" " u " Q >< .c '" =: ~ b ~ :l '2 .,.: 0 '" > "-l <t: >< 15 ;;, " - 0.. ...J o:l "" 0 0 f-. ~ ~ '2 <n "-l " Ul .,.: Ul " " "- :<: >, E-- :r: 0.. '" :r: ~ " ~ " Z f-. ...J Cl. ;::: 0.. :E " ....l 0 '" - '" <t: <t: ~ ,:, 0 ..... ~ Cl. "" ...i u C .,:~ ~ 0 ;z: co Z :l 0 ~ ~ Ct 0 :l Z '" "-l U ~ ~ , is .,.: iil - - "-l '0 ~ " <A ;; <>: N 0.. :r:: '" 0 ~ ;::: 0 " Z .0 '0 -"' " E ~ c ~ :l 0 ....l U rr: a:l Inventory of the real an personal estate of Helen I. Sheelv , deceased 1. 533 W. Louther Street, Carlisle, PA TOTAL......................................... . $88,000 00 840 00 200 03 51,704 89 30,966 54 1,014 00 13,594 69 17,901 41 $204,221 56 2. Travelers Checks 3. M & T Bank - Savings Account 25004920036173 4. M & T Bank - Checking Account - 436798 5. Waypoint Bank - Savings Account 1700000337 6. Personal Property 7. M & T Bank - Certificate of Deposit. 31003910198413 1/2 interest 8. M & T Bank - Savings Account - 15004201315048 '12 interest COMMONWEALTH OF PENNSYLVANIA : SS COUNTY OF CUMBERLAND Prudence L. Sheelv , heing duly sworn according to law, deposes and says that she is the Executrix of the Estate of Helen L. Sheelv , late of Carlisle Borough Cumberland County, Pennsylvania, deceased and that the within is an inventory made by Prudence L. Sheelv the said Executrix of the entire estate of said decedent, consisting of all the personal property and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value as of the date of decedent's death. Sworn and subscribed before me, rtL this ~ day of Avril ,2005.} _L .-f/'e -.6 ~~~ Prudence L. Sheely, Executrrix 533 W. Louther Street Carlisle. PA 170]3 Address Day ]2 Month 2004 Year INSTRUCTIONS 1 . An inventory must be filed within three months after appointment of personal representati ve. 2. A supplement inventory must be filed within thirty days of discovery of additional assets. '..,.1 3, Additional sheets may be attached as to personalty or realty. 4. See Article IV, Fiduciaries Act of 1949. .,,; " ~ '" " " " Cl >- of of ;;.. f-< Ul " '= ::t; f-< 0 '" ~ CU >- ~ > I -< 0 '>', 0 0. f-< ..J ctl 0 CU ~ I CU on " Eo< :r: ~ '" uJ ~ 03 Z f-< - ..J u.. :r: 0. f ..J -< 0 on '"C "' r.1 -< '" ;:.., l'- u.. '" ..J u >- 0 Z ::t; c I 0 z " -+ Z on Cl <-:.l 0 9 i '" Z ..J U ..... '" -< W-l "" n 0. :r: " '" ~ ,; ... '"C z II 0 " " .g "" II rn ;; ,!; ..J U ii: .;,. - - - f-< - H " Cl) ~ 0. :2>-> u ~ :E ~ <ii' ~ " " ~ '" :::E t2 OJ' :r ~i ?I ~,I " II -'" o o ctl Inventory of the real an personal estate of Helen I. Sheelv " . .. , deceased * .' 1. Transamerica - Annuity Number 40645947 TOTAL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $53,705 88 $53,705 88 OFFICIAL USE ONLY REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT REV-1500 EX .. (6~OO) CAPB HpRL EplO CRAC KOTK ES C P o 0 R N R 0 E E S N T FILE NUMBER o E C E o E N T COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG. PA 17128-060t DECEDENT'S NAME (LAST. FIRST. AND MIDDLE INITIAL) 21.04-1173 NUMBER COUNTY CODE YEAR SOCIAL SECURITY NUMBER 191-18-4607 THIS RETURN MUST BE FilED IN DUPLICATE WITH THE SHEELY HELEN L. DATE OF DEATH (MM-DO-YEAR) REGISTER OF WILLS SOCIAL SECURITY NUMBER 1. Original Return 4. limited Estate X 6. Decedent Died Testate (AttachcopyofWifI) D 9. Litigation Proceeds Received X 2. Supplemental Return 4a. Future Interest Compromise (d.:ate of death after t2-12~82) 7. Decedent Maintained a L.iving Trust (Attach copy of Trust) D 10. Spousal Poverty Credit 3. date of death . Remamder Return prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11. Electicm to tax under Sec. 9113(A) (date of death between 12-31~91 and 1-1-95) (Attach Sch 0) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE & CONFIDENTIAL TAX II/FORMATION SHOULD BE DIRECTED TO, NAME COMPLETE MAlUNGADDRESS . Marcus A. McKni ht Es . FIRM NAME {If Applicable} IRWIN & McKNIGHT TELEPHONE NUMBER 60 West Pomfret Street West Pomfret Professional Bldg. Carlisle, PA 17013 R E C A P I T U L A T I o N 24 -235 Real Estate (Schedule A) Stocks and Bonds (Schedule B) Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7} (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule J) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (8) 53,705.88 (11) 3.430.00 (12) 50,275.88 (13) (14) 50,275.88 (1) (2) (3) None None None OFFICIALUSE ONl '( , -) I (4) (5) None None (6) None '..1 J.\ 53,705.88 3,430.00 None C o M P I V X A T I o N SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(aX1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. """:GH!!l~!(:"i'I!!ll\!!l""I!1:~,li!\!:,*!l!!l:~QQ!ii$':t! '>>'"IIE$!JFlEtc>",.$'Nl;A"At 0.00 X .0 0 .. (15) 0.00 50,275.88 X .045 (16) ,2,262.41 0.00 X .12 (17) 0.00 0.00 X .15 (18) 0.00 (19) 2,262.41 Copyright (c) 2000 form software only The Lackner Group, Inc. FormREV-1500 EX (Rev. 6-00) ., Decedent's Complete Address: STREET ADDRESS 533 W. Louther Street CITY I STATE I ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 2,262.41 Total CredITs ( A + B + C) (2) 0.00 3. Interest/Penalty if applicable D.lnterest 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 Pa~e 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) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) Make Check Payable 10: REGISTER OF WillS, AGENT 0.00 0.00 2,262.41 0.00 2,262.41 !iiU:: '"-",, i;X,j '!I~;;!f~;~'!~~~!~~~~;I~f~!.~tbcKS Did decedent make a transfer and: a. retain the use or income of the property transferred; b. retain the right to designate who shall use the property transferred or its income; . c. retain a reversionary interest; or. . d. receive the promise for life of either payments, benefits or care? 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? . 3. Did decedent own an ~in trust for" or payable upon death bank account or security at his or her death? . 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FilE IT AS PART OF THE RETURN. Yes No ~~ o o [R] [R] o rn Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it Is true, correct and complete. Declaration of preparer other than the personal representative is based on all informatlon of which preparer has any knowledge. SIGNATUREOF PERSON RESPONSIBLE FOR FILING RETURN Prudence L. Sheely 533 W. Louther St. ---ca;'Yi~i;'-,-- PI\- - i'i613- ---- - - ------ --- ----- - ----- IRWIN & McKNIGHT 60 West Pomfret Street ---ca;'Yi~i;'-- -PI\- - i'i613- - - -- - ------ - ---- - - -- - -- - -- DATE For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 9116( 1.2) [72 P.S. 9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(aX1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) REV-1510 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF HELEN L. SHEELY SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY 5511 191-18-4607 12/08/2004 FILE NUMBER 21- 04-1173 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. DESCRIPTION OF PROPERTY % OF ITEM R ELA W5~M~I~ t~ b~~~B~~TTttJJ~~~1fAET~EJF t~~~RSFER. DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE NUMBER ATTACH ACOPYOF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPliCABLE) 1 Transamerica - Annuity 53,705.88 53,705.88 Number 40645947 TOTAL (Also enter on line 7. Recapitulation) $ 53,705.88 (If more space is needed, insert additional sheets at the same size) Copyright (c) 1996 form software only CPSystems, Inc. Farm REV-1510 EX (Rev. 1-97) REV 1511 EX +(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF HELEN L. SHEELY SSfI 191-18-4607 12/08/2004 FILE NUMBER 21-04-1173 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES, B. ADMINISTRATIVE COSTS, 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number{s) I EIN Number of Personal Representative(s) Street Address City State Zip - Year{s) Commission Paid: 2. Attorney's Fees IRWIN & McKNIGHT 3,400.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip - Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Register of Wills - Filing Fee 30.00 TOTAL (Also enter on line 9, Recapitulation) $ 3,430.00 (If more space is needed, insert additional sheets of the same size) Copyright (e) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97) REV-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF HELEN L. SHEELY SSlt 191-18-4607 12/08/2004 FILE NUMBER 21- 04 -1173 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List T,ustee(s) OF ESTATE 1 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributIons, and transfers under Sec. 9116(a)(1.2)] Prudence L. Sheely 533 W. Louther Street Carlisle, PA 17013 Daughter Remainder NUMBER I. ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18. AS APPROPRIATE. ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS, A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- 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) Copyright (c) 2.000 form software only The Lackner Group, Inc. 0.00 Form RE"-1513 EX (Rev. 9-00) . tT~~~~Rf~^ . Transamerica Occidental Life Insurance Company 4333 Edgewood Road NE PO Box 3183 Cedar Rapids, Iowa 52406-3183 January 11, 2005 Prudence L Sheely 533 West Louther Carlisle PA 17013 RE: Annuity Number 40645947 Dear Prudence L Sheely: We have received notification, Helen L Sheely, annuitant of the above listed non-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: Annuity Policy Date: Full Value as of 12-08-2004: Taxable Portion: Helen L Sheely Helen L Sheely Prudence L Sheely 03-28-1989- :2..' c <'c, $53,705.88- $33,705.88' The attached document reflects the options available to the primary beneficiary 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 Occidental Life Insurance 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. '... <"'1 .. "" (LCGO .oSoo rqA:.. Member of the .EGON. Group ....'........,' .. ., . .- Any additional questions regarding this annuity can be directed to the Annuity Service Center at 1-800-821-9090. A Transamerica Occidental Life Insurance Company representative will gladly assist you with any questions you may have regarding this annuity and help you meet your financial goals. Sincerely, ;:;tL~()Co,=uil Kelly OConnell Transamerica Occidental Life Insurance Company Claims Enclosure(s) Annuity Claimants Statement Postage Paid Return Envelope Death Option Packet C 110f,;1.~ ~AlTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 28D601 HARRISBURG. PA 17128.0601 REV~ 1162 EX( 11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT MCKNIGHT MARCUS A III 60 W POMFRET STREET CARLISLE, PA 17013 ______u fold ESTATE INFORMATION: SSN: 191-18-4607 FILE NUMBER: 2104-1173 DECEDENT NAME: SHEELY HELEN L DATE OF PAYMENT: 04/05/2005 POSTMARK DATE: 04/05/2005 COUNTY: CUMBERLAND DATE OF DEATH: 12/08/2004 NO. CD 005165 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $2,262.41 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 021904 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $2,262.41 GLENDA FARNER STRASBAUGH REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX BUREAU OF IIIDIVIDU~r J!lIf~S ,_ r, APPRAISEHENT, ALLONANCE OR DISALLOWANCE IMERITANCE TAX 0IVIS10'O,,-, ,lldif-n r.,r:, ,rr (\r OF DEDUCTI-S AND ASSE~~M~ OF TAX PO lOX 2806Gl -..\.- ,n "-"--:,~ 'Li' , flit. ut un ~"''''I HARRISBURG PA 17128-0601 ZOGS flPf? 29 Pr1 12: 02 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN OFI::;( MARCUS A tiaNi~ijiC~IJ1T IRWIN aCMtKltIGHT ' 60 W POMFRET ST CARLISLE PA 17013 04-25-2005 SHEELY 12-08-2004 21 04-1173 CUMBERLAND 101 _t R_Jtt8d ------..___._~H__.."."._~_~_ '* REV-15'~ EX AFP (03-Q5) HE/LEN L I MAKE CHECK PAYABLE AND REMIT PA~ENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS'" . .1r-"1!C"Yf._.m~1..'tm.'fII!".!RM"t'4B.m.l'Mf8TftMMt':.'lC'Ct!l\l'4B.W................. DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX HELEN L FILE NO. 21 04-1173 ACN 101 ESTATE OF SHEELY TAX RETURN liAS: I X I ACCEPTED AS FILED I I CHANllED APPROVED DEDUCTIONS AND EXEMPTIONS: 9. F........1 E__s/AdIIo. Costollllsc. E__. ISchedu1. HI 191 10. Debts/NDrt_ U"'llI.U.s/U...s ISc:hoodu1. II 1101 .00 I 11. Tot.l _Uons 11ll ~1 .:>1;5 1;1 12. H.t V.lu. of T_ R.turn (12) ~82,966.05 13. Chsrl.t"'l./Govsrnsontsl Bsqu.sts; Nan-.1sct8d 9113 Trusts ISchsdul. JI 1131 i .00 1'1. H.t V.lu. of Est.t. Subjsct to T.x 11'11 ~82,966. 05 NOTE: I~ an ........nt was issu.d previOUSly, lin.s 1~. 15 and/or 16. 17. 18 ~d 19 will r~lllCt ~igur.. 'that inclUde the 'tatal ~ 4b!. return. ......ed to dat.. i ASSESSMENT OF TAX: I 15. _t of U... 1'1 .t Spou..l r.t. 1151 .00 X 00 = ' 16. _t of LJ... 1'1 t_l. .t U....l/Cl.ss A ....t. 1161 182,966 . 05 X 0105 ~, 17. _t of U... 1'1 .t Sibling ....t. (17) .00 x 12 ~ 18. _t of LI.... 1'1 t_"'l. .t C011.t.....l/Cbss B r.t. 1181 .00 x 15 = i 19. Prl.nel.....l T.x au. 1191= I I I I I 1 I RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. R..l Estst. I_I. A) 2. Stoeks _ Bonds ISchedub BI 3. ClOHly "-ld Stoek/r.r_rshl.p Int.....st ISchedul. CI 'I. IIort........s/NDt.s R_b...l. ISchedul. D) 5. ~ hposJtolllJsc. P.rs_l Pr_rty I_I. EI 6. Jol.ntly _ P,"-rty I_I. FI 7. TrMsfers (Sdwdul. en 8. Total ASHts III 121 (3) I'll 151 161 (7) 88,000.00 .00 .00 .00 84.725.46 31.496.10 .00 (8) 21. 255.51 AIIIIUNT PAID ,821.80 DATE 02-16-2005 IIUIlBER CD0049 9 INTEREST/PEN PAID 1- I 4 1. 67 ~ TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. DATE 104-25-2005 I NOTE: Tt:' 1n...... p,"-r creell t your account, _it _r porUon of thlsjfOr. with your t.x _to 1 I 2iOIt, 221. 56 .00 8,233.107 .00 .00 8,233.107 :8,233.47 .00 .00 .00 I IF TOTAL DUE IS LESS THAN tl, NO PAYIIEHT IS ~IRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YDU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FUR D1STRlICTIDIlS.)