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
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
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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
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U
L
A
T
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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.
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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
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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
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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,
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Charlene Warrington, Records Management
1-888-502-4349
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l"l WaYR.qi!lt
12/24/2004
IRWIN & MCKNIGHT
60 W POMFRET ST
CARLISLE PA 17013-3222
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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
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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
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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.
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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.
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Inventory of the real an personal estate of
Helen I. Sheelv
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, deceased
*
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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)
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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
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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 '(
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(4)
(5)
None
None
(6)
None
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53,705.88
3,430.00
None
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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::
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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.)