HomeMy WebLinkAbout08-09-13 (2) � 1505610140
REV����O � {O1.tU)
PA DepeRmenl 01 Revenue OF�tCIAL USE ONIY
Bureauofiiru�ividuat-raxes �{�HEi2ITANCE7AXRE7URN GounryCode Year FAeNUmber
ao sax zaoso� 2 1 1 2 0 6 3 9
Marriatrum.PA 17128-0607 RESIDENT DECEDENT
ENTER DECEDENT IN�ORMATIQN BELOW
Saiai Security Number 4ata of[7eath r�ooYYrr Date of Birth MMOOm'v
I] 5 1 � 2 0 1 2 U 3 U 1 1 9 2 1
DecedenCs Last Name Suffl�c Decadenfs Fint Name MI
S C H A F F E R J R J 0 H N
(If App�icaRrie)Enter Surviring Spouse's Infortnatlon Bsiaw
Spouse's t.ast Name Suffix Spouse's First Name MI
Spouse's Sociat Sewriry Number
THIS RETIlRN MUST 8E FlI.ED IN DUPLIGATE WITH THE
REGISTER OF WILLS
FlLL IN APPRBPRIATE OYALS BELOW
Q L Origioal ReWrn � 2.Supplemental Retum � 3.Remainder Retum(date of death
priorto 12.13-82j
� A.Limited Estake � 4e.Puture Interest Compromise(date of � 5.Federal Eatate Tax Retum Required
deatb eftar 12•12-82}
❑X &.pecadeM Died Teatate � 7.Decedant Maintained a living Trust � 8.Total Number o/Safe peposit Boxes
(Attach Copy of Wiii} (Attach Copy of Trust}
� 9.Litigation Proceeda Received � 1 Q.Spousal Poverty CredN(dste of death � 11.Election to tax untler Sec.9113(A)
befimeen t231-9t emi t-1-95} (Attach Sch.4}
CORRESPONDENT-THIS SECT�N MIU$7�COY�IETED.ALL CQRRESPONOENCE AND C4NFIDENTWL TAX INFORMATpN 8HOUlD BE DIRECTED T0:
Name Daytime Telephor�.tlumber
S U S A N H • C 0 N F A I R 7�,07 7 6�3 �r*� 8 3
,: �
��I;,�ER 0 T LLS��Y
a C"J
F` Z � ��i {'rl
First line of address � � u'r � � "`" G
C G)
2 3 3 1 M A R K E T S T R E E T � " �' `" �' �''
� r� �,:� � .i
Sacond line of address � � � -�= ��
. � �.._� i xt
'g
�. <.a � a �l
City or Post O(fice Staie ZIP Code __ Drk'r�FIIED _�'�!__
C A M P H I L L P A 1 7 CI 1 1
CorresponuenYse�maliaddress: SCONFAIRBREAGERADIERPt•tOM
u�Denelke*ot carjun��aedare mat�t�ve eueminad tlNa�easn.irw4uanp eccampenyinp�iWea aw smtements.�a k�a�e beat ot my k�,Meage and beuet
R Is Uue,�and compbte.pedaratlon W preparer dMr tlian the peraonal rapreae�fative Is based on ati inrormation W wlikh preparer has any kno�NeOpe.
�OF�RSOtt E P4NSfBl�OR FII.iNG r�'Lp�nG,T7'��L SS�/ �
�G� �,,,�(,�, G� z zol3
tl '
406 CHESTNUT WAY NEW CUMBER�AND PA 17070
SIGNATU P EAAfi , RER4THERTHANREPRESEFSTATIVE (/ ATE♦ 7 �
..r✓�L.d�/"1..—r i? 7f-+EiCI'�
AD�ESS
2331 MAftKET STREET CAMP HILL PA 17U11
PIEASE USE ORi6INAl FORM 6NLY
Slde 1
L 15D561014U 1505610140 J
J 1545610240
REY-1500 EX DBCedenCg Social Security Number
oe�,esr� J4HN StHAFFER, JR
RECAPITULATION
1. Real Estate(Schedule A) . .... .. .. . . .. . ... . . . . .. . .. .. . . . .. . .. . . . .. . . 7. 1 S 0 � a 0 . � 0
2. Stocks and Bonds{ScMedule B) ..... ... ... ... ... ... . ... .. . .. ... .. ... . 2� •
3. Closely Held Corporatfon,Partnarship or SolaProprierorship(Schedule C) .. . . . 3. •
4. Mortgagea and Notea Receivable(Schedule p) . .. ... . .... . .. .. ... . . ... .. 4. • �
5. Cash,Bank Deppsits end Miscellaneous Personal Property{Schedule E)... ... . 5. 8 1 c� 7 6 L . 8 1
6. Jointly Owned Property(Schedule F) ❑ Separete Bflling Requested . . ..... 6. 1 7 3 4 � . 1 �
7. �nier-�voa Transfers 8�Misceitarreous N -Probate Property
�sonedma c> � Separate Bflling Requested .. ..... 7. 1 O 1 8 7 2 . 6 8
8. Total Gross Asuts(total U�es 1 through 7) .. .. ... .... . .... . ... ....... 8. � 0 8 1 9 8 1 . 6 2
9. Puneral Expenses and Administradve Costs(Schedule H) .................. 9. 4 2 0 0 4 . 4 3
�o. oetts or oecedeac.Mnrt4age�ieaan;es,and Liena{Schedule 1) ....... ...... 10. 2 6 8 U 9 . 4 9
1 t. Total Otductiaxs{tatal Lines 9 and 10) ............................... 7l. 6 8 8 1 3. 9 2
t2. tiet Vaiue af Estate{�i�8 minsss Line ii} ............................ 72. Y 0 1 3 1 6 7 . ? 0
13. Charitablg and Govemmental BequestslSec 9113 7ruste for which
an eiedicn ta tax has not been made(Sd�dule J} ...................... 13. 6 3 4 9 7 5. 2 3
16. Net Yaiue SubJsck to Ta�c(tine 12 minus line 53) ...................... t4. 3 7 8 1 9 2 , 4 7
TAX CAI.CULATION•SEE INSTRUCTIONS FOR APPUCABLE RATES
15. Amount of Line 14 taxabie
at the spausal tan rate,or
transhrs under Sea 5518
{a){12)X.tl _ 0 . � � �5, �I . I� �
78, Artrount of Line/4 taxabis
at Iinea�rate X.oa5 2 5 0 1 7 1 . 2 9 t s. 1 1 2 5 7 . 7 1
17. Amount of Lina 14 taxable
at sib�i�rate x.tz 3 9 6 ? 7 . 9 1 �z 4 7 6 1 . 3 5
18. Ampunt 4f Line 14 tauable
at collateral rate X.15 8 8 3 4 3 . 2 7 t e. 1 3 2 5 1 . 4 9
19. TAX DUE ..................... ................................. 19. 2 9 2 7 0 . 5 5
20. Fll�IN 7NE OYAL IF YQU ARE REqUESTING A REFUND OF AN OVERPAYMENT �
Side 2
� 15U5610240 150561�240 �
REV-1500 EX Page 3 Flla Numbar
Deaedent's Complete Address: �1 sa D639
DECE�NTS NAME
J4HN StHAFfER, JR__„ �_____,�_,i_ _____—__—. —.
STREETADDRESS
64 R011ND RIDGE R4AD _� �_____________,______.__—..—.—_—_�_
CITY '—��—'—�!� i STATE ` 21P �--i-'--
MECHANICSBURG PA 17055
Tax Payments and Credits:
t� T�pue{Pa�2,Une19} {t) 24,2?Q.55
2. Credits/Payments
A.Pria Payrr�ts 33,8 b2=77
B.Discount 1,463.53 TotafCrer�ts{A+B
} t2) 35,276•30
3. Interest
ta}
4. If Line 2 is grealer than Line 1 +Line 3,enter the difference.Thfs is the OVERPAYMENT.
fNi in ovai on Page 2,Line 26 ta roqtroft a radmxl. {4} 6,005.75
5. If Line t+line 3 is greater than tine 2,enter ihe d+ffererice.This is fhe TA7(DtlE. (5} p.p p
Make check payable to: REGISTER OF WILLS, AGENT
;. �
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN"X°IN THE APFROPRIATE BLOCKS
1. pid deoedertit make a hansfer and: Yes No
a. ret�n the use w income ot the property Vansfened� ...................................................................... ❑ �
b. retain the right to designate who shaii uss fhe property transferted or its lncome: ............................... ❑ �
c. cet�n a reversia��y inisrsst�� ................................................................................................ ❑ �
d. recsive fhs pranise fa life of either payments,beneflt�or care? ....................................................... ❑ �
2. If deaih occurred after 6ecember 12,1982,did decedent transfer property within ais year�f death
without rec�ving adequate consideration7 ....................................................................................... ❑ �
3. pid decedent own an'in trust Por or payaWe-upon-deffih bank account or security at his a her deathfi ......... ❑ �
4. �d dea�sdent arm�r i�div�u�retirerr�t�nt,�nuity a ott�nar�-prob�e property,which
conWins 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.
� '��'�
Far dates of desth o��atter Juiy 1,199d,and before San.1,1995,the tax rate imposed an tl3e net value of transfers to ar for the use af the surviving spouse is
s pe�ce�,c[r2 a.s.gs>>s�a)(�.1)p)].
For dates of death on or after Jan. t, 1995,fhe tax rete imposed on the net value of hansfers to or for fhe use of the surviving spouse is 0 percent
j72 P.S.§9116{a}{1.i){ii}j.The statute does nat e�mpt a transter to a surviving spause fr�t t�,and me sRatutory requUemenGs for disdasure of assets and
filing a tau retum are still applicable even if lfie surviving spouse is the only beneficiary.
For dates of dealh on or after Juiy 1,2W0:
• The tax rate impas�an tl�e net value of transfers fran a deceased Child 21 years of age or younger at deatl�to or for the uss of a naiurel parent,an
adoptive parent ar a stepparent of the child is 0 percent[!Z P.S.§9116(a)(12}],
• The tau rate imposed on the net vaiue of transfars to or for the nse of the decedenYs Iineal t�rrefiaaries is 4.5 perc�nt,axc�t as noted in
72 P.S.§9116{1.2)(72 P.S.§9118(a)(1)�•
• The tax rate imposed on the net value of transfers to or for the use of the decedenPs sibiings is 12 peroent[7'2 P.S.§9116(aj(i.3)j.A sibNng is defined,under
Section S1d2,a5 an isx#viduai who has at leask a�e parent in canmon with ttre decedent,wheU�et by bbod or adop6an.
� .
REV-1502 EX+(Ot•10)
pennsylvania SCHEDULE A
OEPMTMENT OF 0.EVENUE
REAL ESTATE
INHEWTMlCE TAJ(RETURN
RESIDENT OECEDENT
ESTATE OF: FILE NUMBER:
JOHN SCHAFFER, JR 21 12 ❑639
All roel propeAy owned soieiy or as a tenant in common muat be reported at hir market value.Fair maAcet value is defined as Me qrice at vAm�propeRy
vra�id be exchanged baivreen a wiiling buyer ar�d a wiliing seil�,rreiiher being�npelled to buy a sell,tpth haring reasonaWe knowledge of the relevant(xts.
Real propeRy thak b jo4�Nyyownsd with rigM of survivorohip muat be diseloeed on Scheduk F.
Attach a copy�the setUement sheet if the property h�been sdd.
�T� Indude a copy of the deed ahowing decz+denPs i�terest if rxxnsd as tenant in common. VALUE AT DATE
NUMBER pF DEATH
DESGRIPTIQN
64 R6UND RID6E ROAD, UPPER AILEN T061NSHZP, t{ECNABICSBURG, 150,0�0-{1Q
tUI1BERLAND CBUNTY, SETT�Et9ENT SHEET ATTACHED
T4TAl{Alsoent�onLinet,fterzpi{ulatfon.) S 15U,fl0�.�0
itma�esp[�'sneeded,�e �sotpaperdmeserrea�m.
REVd 508 F_7C+(11•10)
pennsylvania SCHEDULE E
DEPARTMENTOFREVENUE
CASH, BANK DEPOSITS, & MISC.
�sioErir�cE�r�ir;UR" PERSONAL PROPERTY
ESTATE Of: F�E NUt�ER:
J4HN SGHAFFER, JR 21 12 0639
indude d�e P�eeds of Atlgafio�and the da8a iheproceed�ware reoaived by u+e eefeAe,
AN pro p ovmM wMh rlpM of�urvivon Ih p muRt M dhebMW on ScMduN F.
ITEM VALUE AT dATE
NUMBER DESCRIPTION OF DEATH
1. TAX/SEWER/HOMEOWNER'S ASSOCIATIBN CREDIT FROM SETTLEMENT ?20.21
SNEET F4R SA�E OF 64 R6llMD RZ4GE ROAD, MECHANZGSBUR6, PA
2• 2005 BUICK LESABRE 5,?40.Oi7
3. PERSONAL PR4PERTY — CIN4Y FENTQN AUCTI4N 586.�U
4• FULTON BANK — CERTIFICTATE OF DEPOSIT 502,411.24
P8 86X 4$87
LANCASTER, PA 176�4
5• FpLTON BANK — CNECKING ACtOUNT 17,339.38
PO 80X 48$7
LANCASTER, pA 17604
6� ATLANTA PQSTAL GREDZT UNZON — SAVINGS ALtOUNT 52,14�•6�
3900 CROWN ROAD
ATIANTA, GA 30380-0001
7. ATIANTA POSTAL GREDIT UNION — {HECKING ACC4UNT 25,852.02
39p0 CROWN ROAD
AT�ANTA, GA 3�380—�601
8• ATLANTA POSTAL CREDIT UNIpN — CERTIFICATE OF DEPOSST 50,925.16
3900 CR6WN RBAD
ATLANTA, GA 3�38�-DOU1
9• ATLANTA POSTAL tREDIT UNION — CERTIFItATE 8F DEPOSIT 151,278•15
39U� LR4i�N RQAD
ATLANTA, GA 30380-0001
1�• UNITED STATE 4FFICE �F PERSdNNEI ilANA6EMENT RETZRElIENT — RENSZON 1,tl46.58
11. FULTQN BANK — RETURN OF SAfE DEPOSIT 84X FEE (SAFE DEPOSIT 15�00
BOX CLOSED PRIOR TO DEATH)
12. VA PAYMENT FOR FUNERAL 1,560�0❑
13. ERIE INSURANCE — REFUND F4R H6MEOWNER'S INSURANtf P6lICY 274.0�
14. YBRK WASTE MANAGEttENT — REFUND F8ft TRASH BIII 11.50
15. REPRIGERATOR SOLD 100•00
16. IRS INCOME TAX REFUND 1,818•00
TOTAL(Also eoter on Line 5,Recapilulation) S b 12,761•B 1
If mae spaoe b needed,insert additional aheels o(paper oifhe same sae
i�
Continuatian of REV-1500 Inheritance Tax Return Resident Decedent
JOHIdSCNAFFER,JR 21 12 O6S9
DecedeM's Nama Page 1 File Number
Schedule E-Cash, Bank Deposita,&Misc. Perraonal Properiy
ITEA4 VALUE AT pATE
NUMBER DESCRIPTION OF DEATH
17- INtERESS 4N ESTATE AiCOUNT 208�77
1b• GEMETERY pLOT 500.�0
19• ERIE INSURANCE REFUND 1i5�00
20• PPL REFUND 30�20
21- H4ME 61ARRAWTY ftEFUND FROFt OVERAGE 30.��
SU9TOTALSCNEDULEE 943•9?
GRANDTOTALSCHEDULEE S 812,761.81
�m
REV-1509 EX+(01-10)
pennsylvania SCHEDULE F
OEPARTMENiOFREVENU£ �QINTLY•OWNEDPROPERTY
iNtiERITAt�TAX RETUtN:
RESIDENT OECEDENT
ESTATE QF: F�E NUTABER:
J4NN SCHAFFER, JR 21 12 0639
If an aaaet waa made Jolntty owned wiMin one year of the deeedenPa date of death,ft mutt ba reported on Schedule G.
SURYMNG JOINT TENANT{S)NAME(S) ADDRESS RELATIONSMIP TO DECEpENT
A. RICHARD KELl.Y, II 23U6 NORTH 128TH STREET GRANDSON
SEATTLE, WA 98133-7850
B.flEGAN QUILAN Ndld TH8t9AS 214 ME�$OURNE PIACE 6RANDAU6HTER
MECNANICSBURG, PA 17055
C.MOLLY KELLY 101 NORTH SECpND STREET 6RANbAUGHTER
�ORt1�EYS9UR5, PA 17fl43
JOINTLY-0YYNED PRQPERTY:
I.ETTEF DATE pESCPoPTIONOFPROPERTY %OF DATEQFOEATH
ITEM FORJOINT IA4DE INCLUDE N4ME OF FlNANCIAI.INSTITUTION AND BANK ACCpUNT NUMBER 4R SIMIIAR CIATE pF DEATH DECEDENT'S VALUE OF
NUM1�Eft TENANT .�INT I�MIFYINGNtlMBER.ATtACHOEEDfOR�01NTtY-tiELDREALESTATE. VALUEOfASSET INTEREST 6ECE�Nt'SINTEREST
1. A. �9tbD ATIANTA P4STAL tREDIT UNZQN 1,039.69 SQ. 519.85
JOINT ACCOUNT
2. B. �9/1� ATLAkTA POSTAL CREDIT UNION 135�92 50. 67.96
JOINT ACCOUNT
3• C. 09/10 ATLANTA POSTAL CREDIT UNION 135�48 50. 67•74
JQINT ACGOUNT
4• D. 09110 ATLANTA POSTAL tREDIT UNION 33,383.bb SCf. Z6,691•Sa
JOINT ACGOUNT
TOTAL(Also enter on Une 6,Recapitulation) S y7,34 7•13
If more spec:e b needed,use addldonai sheeb of peper ot Me�me size.
Cantinuation of REV-15041nheritance Tax Return Resident Decedent
JOHN SCHAFFER,JR 21 12 4638
DecetlenPS Name Page 2 File Number
Schedule F-1 -Jotntly Owned Property
SURYMNGlOINT TENANT(S}NAME(S} ADORESS REIATIONSH4F TO QECE6ENT
d SCOTT KELIY 894 CEDARS ROAD GRANDS4N
LEWISBERRY, PA 17339
REV-i 510 EX�{09-09)
pennsylvania SCHEDULE G
DEPhRTMEHi OR RE4ENUE iNTER-VIVO5 TRANSFERS AND
�ru�T,w�r,ixRET� MISC.N4N-PROBATE PRC}PER7Y
�sioeMr�c�o�M
ESTATE OF fiLE NUMBER
d4NN SCHAFfER, JR 21 12 0639
Thb scheduW muat be completed and filad H Ihe 0nawer to am/qf quesWns 1 tl�rough 4 on page ihree of Ihe REV•150p Vs yes,
DESCRIPTil7N OF PROPERN
ITEM �q,��p�#�Tnu��,�s�uFw�swProo�c�urqNp DATEQFDEATH %OFDECD'S EXCLUSION TAXABLE
NUMBER n�o��arnnHSC�a.nn,uxACarvan+eoemrarsrsFU[snh. VALUEOFASSfT iM7EREST �un,c•a� VAI_UE �
1. ATLANTA P4STAL CREDIT UNSON —CERTIPICATE 4F 101,872-6$ 14U•�� 101,872�6B
DEPOSIT — BENEFICIARY JOAN SCHAFFER GAVIGAN —
DAUGHTER
TOTAI. AlsoenteronLlne7,Recapitulation ; 1�1,b72•6$
If mpre space b needed,u5e additlonel gheets af paper of the same atre.
REV-1517 EX.{70-09J
pennsylvania SCHEDULE H
DEPARtMENTOFftELENUE FUNERAL EXPENSES AND
�"�'T"'�T"x'�TU� ADMINISTRATIVE COSTS
RESIOENT OECEDENi
ESTATE OF filE NUt18ER
JBHN SfHAFfER, Jft 21 12 0639
Deeed9M's debb muft be reporkd on Schedule I.
ITEM
NUbiBER DESGRIPTI4N AM�tlNT
A. FUNERAIEXPENSES:
1. PARTHEMORE FUNERAL HOfi1E 8,866•92
B. ADMINIS7RATVVE GOSTS:
1. Personal Represe�tative Canmissions:
Name(s)MPersonalRepreseMS6ve(s) JOAN GAVIGpN 15,000.00
StraetAddress 466 tNESTNUT I�AY
��y NEW CUMBER�AND S�� PA Zip 3707�
Y�r{s)Canrttisabn Pakl; 2013
p, AtromeyFees: REA6ER 8 ADLER, PC 15,000.��
3. F�y Exemp6on:(if decedenCs address�rntttre same as�Jaanam's�at1a�exPia�atlon.)
Claimant
SUeet Address
City Sis� ZIP
R ' �CIa�MtoOecedent
¢. Proba�Fees CUt1BERlAND COUNTY RE�ZSTER QF WZL�S ?73•5�
5 Acooumm�tFees: GRfENAWALT AND t011PANY, Pt 970.00
6. Tax ReWm Preparer Fees:
7. FZLING FEE — INNERITANCE TAx RETUftN 3�.��
8. EXPENSES PAID BY JOAN GAVIGAN, EXECUTRIx AND REpAID T4 HER 1,36N•61
TOTAL(AlsaenteronLine9,Recapituiatron} S y2,004•43
if mwe�is needetl.use�d#bnai shee�W psperattt�smne tdZe.
REV.1512£Xi{t2-OB}
pennsylvania SCHEDULE I
OEPARiMENTOf REVENUE DEBfiS OF DECEDENT,
�,�a,Tr���c�T�++ MORTGAGE I.tABILiT1ES,8 LIENS
a�sioerrt r�cEOENr
ESTATE OF flLE NUMBER
JBNN SCHAFFER, JR 21 12 q639
Report dabb incumd by the deeedent�r to�h that remained uapald at the data of daf�h.including unraimbunad medleal e�cpeneea.
1TEM VALUE AT DATE
NUMBER DESCRIPTION dF DEATH
� i, SELLER CREDIT fOR CtOSIN6 COST FRBTI SALE 6F REAI ESTATE AT 1,500.00
64 ROUN4 RIDGf RQAD, 17ECHANICSBURG, PA 17�55
2• REAI ESTATE tOMMZSST4N fR4t1 SAIE OP ftEA�. ESTATE AT 9,4511•QD
64 ROUND RIDGE ROAD, MECHANICSBUR�, PA 17055
3• EARNEST MONEY DEPOSTT FROM SAI.E OF REAL ESTATE AT 1,275�00
64 ROUND RIDGE ROAD, MECHANICSBURG, PA 17055
4• 1% TRANSFER TAX FROM SALE OF REAL ESTATE AT 1,SOO.DO
b4 ROUND RIB6E ROAD, MECHANZCSBURG, PA 17ti55
5• N6TARY/2ND QUARTER SEWERlHBME WARRANTYlRESALE CERTZFZ{ATE FRBEt 591•04
SAIE OP 64 ROUND RIDGE ROAD, MECNANICS9URG, PA 17U55
6� IAWNSCAPES - LAWN MAINTENAB{E F8R 1,392.6$
64 ROUND RIDGE ROAD, MECHANICSBURG, PA 17055
7• UPPER ALIEN TOWNSHIp - SEWER 449.00
8• CINDY FENTON - APPRAISpL FEE FOR PERSdNAL PROPERTY 50.00
9• BENNIS ZERBE, TAX tBLtECTOR - 26b212613 SCH06L REAL ESTATE SAXES 2,OA2.12
10. RSR - APPRAISAI FOft 64 R011ND RiDGE ROAD, MEtHAN2tSBURG, PA 450•O4
b1. YORK WASTE MANAGEMENT - TRASH PICKUP 38•85
12• ERIE INSURANCE CO• - H6MEOWNER'S INSURANCE b3"?�00
13• 11E6AN TNOMAS - REPAYMENT F6R UTILITZES 350•35
14. JBAN GAVT&AN - PAINT FOR FRONT DQOR 4P 64 RQUN4 RTDGE ROAD, 2S•3b
MECHANICSBURG, PA
15. IJNITED WATER - WATER 9L•54
TOTAL(Aiso enfer�Ur�e 10,RecapiWlaG�} S 26,809-49
If rtare apace b needed,insertadditlonal sheeb flf the same size.
Cantinuation af REV-154Q Inheritance Tax Return Resident Decedent
JdHN SCHAFFER,JR 21 12 Q639
DecetlenPs Neme Page 3 File Number
Schedule I-Deb#s of Decedent, Mortgage Ltabilfties,& Liens
iTEM
NUMBER pESCRIPTION AMOUNT
16. PPI. - ELECSRTC 540.57
1?. J4NN MUTZABAUGH - REMOVAL OF BASEMENT TRASH AT 64 R011ND RIDGE R4AD 450.00
MECHANICSBURG, PA
18. RENOVATIONS - IMPROVEMENTS AND REPAIRS FOR SALE OF 64 ROUND RIDGE 3,020.�0
ROAD, MECHANZCSBURG, PA
19• BOWMANS HILL H011EOWNER ASS6CIATION - ANNUAI DUES 2013 65�00
20. DENNIS ZERBE, TAR tBILEtTOR - 2013 COUNTYISBYNSHIP REAI ESTATE 6Z8.7�
TAXES
21- PA BEPkRTMENT OF REVENUE - 2012 TAXES 162•�0
22• F►M1 BERKHEIIIER HVAC - NEW NOT WATER HEATERJTANK/PUMP FOR 1,252.50
64 RpUND RID6E ROAD, MECHANICSBUR6, PA
23• JOAN GAVIGAN - SHRUBBERY AND MULCH FOR 64 ROUND RIDGE ROAD, 60.74
MECNANFCSBUR6, PA
24• RICK 6AVZGAN - LANDSCAPE SERVICE PLUS MILEAbE AND TURNPIKE T4LLS 109.08
F4R 64 ROUND RIDGE R4AD, 11ECHANIGSBtlRG, PA
25. JBAN 6AVSGAN - 6ANDS{APE SERVI{E, tIUICH AND L�EANZNG SERVICES 95•�0
26• HA{KMAN R08FIN6 SIDZNG � SP4UTIN6 - ROOF REPAIR 339•�p
27. CHRIS SHERLOtK - PAINTING 215•�0
28• PA DEPARTMENT OF REVNEUE - 2012/2013 FIDUCIARY TAX 6•Oq
29• FULTBN BANK - CHECK FEE 14•00
SUBTOTALSCHEDULEI ?,OU?•59
GRANOTOTpLSCHEWLEI S 26,809.49
REV4513£x«(p�.�6}
pennsylvania SCHEDU�E J
DEPM'1'MENT Oi REVENUE gENEFICIARIES
INHERITANCE TAX RETURN
RESIOEM OECEDENi
ESTATE OF: Fl�E NUM�R:
JOHN SCHAFFER, JR 21 1 0639
RELATIONSHIP TO 4ECEDENT AMOUNT OR SNARE
NUMSER NAME AP14 At?DRESS OF PERStN�(S)REGEIVING PROPERTY Da Not Lbt Truttae(sj OF ESTATE
i. TAXABIE DISTRIBUTIQNS (i�p�pqht s and transfeta undar
Sec.91i8(a (1.2).j .
t. WIL�IAM HOSIER AND PAT HOSLER Collateral 4,453.18
4U9 SHARON AVENUE
MECHANICSBURG, PA 17055
2� BRIAN CAPRIOTTI Collaterai 649�05
94 E• M1'• AIRY RBAD
DILISBUR6, PA 17639
3• J4AH E. GAVIGAN Lineal 180,997•96
406 CHESTNUT WAY
NEW Nf18ERLAND, PA 17U70
4• MEGAN QUINLAN NOW MEGAN TNOMAS Lineal 23,?SCI•84
214 MELBOURNE PLACE
FIECHANICSBURG, PA 17055
5• PETER K. SCHAFFER Sibiing 39,677•91
1b0� DRANESVZtGE ROAD, APT. 413
HERNDON, VA 20170
6- PETEft K• SCHAfFER, JR. Collateral 19,852•72
?�4 IINCOI.N AVENUE
FAI.LS CHURCH, VA 22046
7• JOHN JOSEPH AND fLAIRE SCNAFFER tollateral 23,682-88
9�3 PEAGHTREE DRIVE
MECHANIfSBURG, PA 17055
ENTER pOLtAft AMOUNTS FQR QVSTRI6UTlONS SHOWN A6QYE ON L4NE315 THROUGH 18 OF REVd500 COVER SHEET,AS APPROPRIATE,
IL t�N-TAXABI£D{STRIBUTI�IS:
A.SPOUSAl01STRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
i. tH2LDREN'S t1IRAClE NETW4RK tI0 6�9,975�23
4FFStE 4F GIFT PLANNZNG
TNE PENNSYLVANIA STATE UNIVERSITY
214 THE 1�3 BUILDING
UNIVERSITY PARK, PA 16802
2• ST. MICHAEL�S EVANGEIItAL LUTHERAN CHURCH 25,�OQ•0�
118 STATE STREET
HARRZSBURG, PA 17107,
T4T�U.OF FART tI-ENTER T4TRt NON-TAXABIE DISTRi8UTi0NS 4N LINE 13 OF REV-550Q COVER SHEET. 3 634,9?5.23
H more space i8 ne9ded,uSe addition�Sheets�papar Of th8 s�ne siZe.
Gantinuation af REV-150Q Inher[tance Tax Return Resident Decedent
JOHN SCfiAFFER,JR 21 12 �39
Decetlent's Name Page 4 File Number
5chedule J -Beneflciaries-t
REIATIONSHIP TO pECEpENT AMOUNT OR SHARE
NUMBER NAME AN�ADDRESS QF PERSON S RECEIVING PR(7PERTY Do Not Lht TnN � OF ESTATE
T TAXABI.E DISTRI6UTIQNS [in�auklaM �tlons aru!tr�s uruler
Sea91i6(a (72).)
8. ANDREW SCHAFFER tallateral 19,852•72
1550 Y4UNGS P4INT PLACE
NERNDON, VA 2U170
9. L6NSTANt6 84CKST4tE Collaterel 19,852.72
33 ELLEN GLEN WAY
DAtLAS, GA 3d132
1�. SCOTT C. KELIY Lineal 40,374.46
894 CEDARS ROAA
LE41ZS8ERRY, PA 17339
11. TNOMAS SCOTT KELLY C/0 MO�LY E• kELLY Lineal 3,947.15
101 NBRTH SEC4ND STREET
WORMI.EYS9UR6, pA 17043
12. RICHARD KELLY, II Lineal Sb9.85
23�6 N4RTH 128TN STftEET
SEATTLE, WA 9$133-7850
13� 118LLY KELLY lineal 67.74
1n1 NORTH SECOND STREET
WORMLEYSBURG, PA b?043
14• JANE E- KELIY Lineal 523•29
407 GHESTNUT WAY
NE� CUMSERIAND, PA 1?�7D
.
�f.�p� t�fiGE OF
f�C�,S�tR �� M!LS
2�12 JUN -1 AM Ii� I 8
�;l�.Fi+: C;:
��o�i�
LAST WILL AND TESTAME
I, the undersigned, JOHN SCHAFFER aiso known as JOHN SCHAFFER
JR. presently residing in South Lebanon Township, Lebanon County, Pa, my
address being 1700 South Lincoln Avenue, Bldg. 1, Room 518, Lebanon, PA
17042, do hereby make this as and for my LAST WILL AND T'ESTAMENT, and
I do hereby revoke any and all former Wills by me at any time heretofore made.
1. I direct that all my just debts and funeral expenses shall be paid as soon
as may be convenient after my decease.
2. I direct that all inheritance, estate and succession taxes which become due
and payable by reason of my decease shall be paid out of the principal of my estate
� with the same effect as if said taxes were expenses of administration and the
personal representative of my estate shall have no duty or right to obtain
reimbursement for the payment of any of said taxes.
3. I give and bequeath my automobile to my friends, namely, Wiiliam
Hosler and Pat Hosler, or the survivor of them if either should predecease me,
absolutely.
1
4. I give and bequeath the sum of One Thousand ($1,000.00)Dollars to my
friend, BRYAN CAPRIOT"TI, absolutely, if he survives me.
5. I give the sum of One Hundred Thousand($100,000.00) Dollars to my
daughter, Joan E. Gavigan, if she survives me, absolutely;
6. I give the sum oi Thim;� Tliot�sarid ($3U,OG0.GOi Doilars to my
granddaughter, Megan Quinlan, absohrtely;
7. I give the sum of Fifty Thousand ($50,000.00) Dollazs to my brother,
Peter K. Schaffer, if he survives me, but if he predeceases me, I give said sum to
my nephew, Peter K. Schaffer, Jr., if he survives me.
8. I give the sum of Twenty-five Thousand ($25,000.00) Dollars to my
nephew, Peter K. Schaffer, Jr., if he survives m.e.
� 9. I give �he sum of Thirty 'Thousand ($30,UQOAO) Dollars to my nephew
and his wife, namely, John J�seph S�chaf�er and Claire Schriffer, or the survivor of
diem if one sfiould predecease mz, absolately;
10. I give the sum of Twenty-five Thous�nd ($25,000.00) Dollars to my
nephew, Andrew Schaffer, absolutely, if he survives me;
11. I give the sum of Twenty-five Thousand (�25,U00.00) Dollars to my
niece, Constance Bocksoce, absolutely, if shr smvives me;
�
12. I give the surn of Thirty Thansand ($30,d00:00}Dollars to my
grandsan, Scott C. KeIIy, absolately, if he survives me;
13. I give the sum of Twenty-five Thousand ($25,000.00) Dollars to St.
Michael's Evangelical Latheran Church of Hart isburg, Pennsylvania, absalutely,
ta be administered by the Fastar of the Chtirch;
14. I give the sum of Five Thousand($S,OOOAO)Dollars #o my great-
grandson, Thomas Scott Kelly, to be invested by his mather, Mally E. Kelly, in a
Certificate of Deposit or other similar investment until he is 18 years of age, at
which time the principal and interest sha11 be paid to Thomas Scott Kelly.
]S. All the rest, residue and remainder af rny estate, I give and bequeath
unto Childrens' Miracle Netwark for the use and benefit of Penn States
Childrens' Hospital at Hershey,Pennsylvania, absolutely.
16. I acknowledge that I have a daughter, namely, Jane E. Keily, but that I
have intentionally and knowingly omitted her frarn sharing in the benefits of my
Estate.
1'T, I nominate, aonstirizte and appoint my da�ghter, Joan E. Gavigan, as
Executrix of this my LAST WILL AND TESTAMEN"T, but if she predeceases
rne, or if for any reasan she fails to qualify, or ceases ta serve, then and in that
event I nominate, constitute and appoint, tny granddaughter, Megan Quinlan, as
3
Executrix af this my LAST WILL AND T'ESTANIFNT, and I direct that my said
Executrix, shall not be required to file any Bond.
IN WIT'NE3S WI3EREOF, I have hereunto set my hand and seal, this
�day of .�� lr�rd7��P /r , A. D:, 2011.
� ����1�� ��
(�EAL)
(JOHN SCHAFFER)
Signed, sealed, published an.d declared by 7ohn Schaffer, Testator abave
named, as and for his LAST WII.L AI�TI7 TESIiTAMENT, in the presence of us,
who at his request, in his presenoe and in the presence of eaeh uther,have
hereunto subscribed our names as w' t�s here�
�., - �Y2.�-_'?
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