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HomeMy WebLinkAbout11-27-13 (3) Y t � 1505611185 REV-1500 EX�°Z-",�F', OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of IndMdual Taxes PO BOX 280601 INHERRANCE TAX RETURN 21 13 0 9 3 9 Hanisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social SecuMy Number Date of Death MMDDYYYY Date of Birth MMDDm�r Ob182011 � 04131935 Decedent's Last Name Suffix DecedenYs First Name M I SHIV�LY GEORGE R (If Appllcable)Enter Sunriving Spouse's information Below Spouse's Last Name Suffix Spouse's First Name M I SHIVELY NANCY Spouse's Social Security Number THIS RETURN MUST BE FILEO IN DUPLICATE WITH THE 300-24-7729 REGISTEROFWILLS Flll.IN APPROPRIATE BOXES BEIOW � 1. Originai Retum � 2. Suppiemental Retum Q 3. Remafnder Retum(Date of Death Priorto 12•13-82) ❑ 4. Limited Estate ❑ 4a. Future Interest Compromise(date of ❑ 5. Federal Estate Tax Retum Required death after 12-12-82) � 8. Decedent Died Testate � 7. Decedent Maintained a Living Trust �., 8. Total Number of Safe Deposit Bo�aes (Attach Copy of Will) (Attach Copy of Trust.) ❑ 9. Litigation Proceeds Reoeiv�ed ❑ 10.Spousal Poverty Credit(Date of Death ❑ 11. Electlon ta Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT• TH�SECTION MUST�COMP�ETED.AL�CORRESPONDENCE ANp CONFIDENTIAL TAX INFORMATW�,�OUl.D 8E DIRECTEO TO: Name , D�ne Telephon�umbe� :� w t"'��11 CRAIG A• HATtH, ESQ, CELA �';�731-�Q0� � .� � ER QF_Wl�t�8 . LY rv :'� � --.] � �7 First Line of A�ddress � � � � '�; "T1 � � 21�9 MARKET STREET - � �'' � ,� Second Line of Address � � r rn � � � � � CT) City Or P08t Offi08 Stete ZIP COde DATE FILED CAMP HILL PA 17011 Corr�spond�nY:a-�,Ni.da�: C•H A T C H�H H G L L P•C 0 M Under penaltiea of perjury,i declare that i have examined this retum,induding accompanyfn�achedulea and statemeMs,and to the beat d my kna�wledge a�d belief, it ia tn�e�corn�:t and complete.Declaration of preparer other than the personal repreaentative ia based on�1 Mbrtnatlon of which preParer haa any knoiMsdys. SIGNA RESPONSIBIE FOR FIL E'TURN ,,,� DATE LISA A• MYERS, EXECUTRIX ZZ Aoo�ss . � 26 K4SER LANE SHIPPE BURG, PA ?25? . SIGNA7URE OF PREPARER 4THER THAN REPRESENTA TE CRAIG A. HATCH, ESQ• , CELA ._ �i n�o�ss 2109 MARKET STREET CAMP HILL, PA 17011 PLEASE E RI INAL F RM ONLY Side 1 � 1505611],85 OhA46�73.000 1505611185 ,�,., t � � 1505611285 REV 1500 EX(FI) Decedent's Social Security Number oecedent�sName: SHIVELY GEORGE R RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 0•�0 2. Stocks and Bonds(Schedule B). . . . . . . . . . . . . . . . . . . . . . . . . 2. 0•0� 3. Ctosely Held Corporation,Partnership or Sole-P�oprietorship(Schedule C), , , , , 3. 0•0� 4. Mortgages and Notes Receivable(Schedule D) , , , , , , , , , , , , , , , , , 4, �•0 0 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E) , , , , , 5, �t{.,5�Q•Q Q 6. Jointty Owned Property(Schedule F) � Separate Billing Requested , , , , g, �•�� 7. Inter-�vos Transfers 8 Miscellaneous Non-Pr�ate Property (Schedule G) � Separate Billing Requested . . . . 7. �•�0 e. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . 8. 7 4,5 0 0•0 0 9. Funerai Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . g. 3��Q�•�0 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule I) , , , , , . . . . 10. �•�� 11. Total Deducdons(total Lines 9 and 10), , , , , , , , , , , , , , , , , , , , , ��, 3��0�•�� 12. Net Value of Estate(Line 8 minus Line 11� , , , , , , , , , , , , , , , , , , , �2, 71�5�0•�� 13. Charitable and Governmentai Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J), , , , , , , , , , , , , , , , �3, �•�� 14. Nat Valu4 Subj�ct to Tax(Line 12 minus Line 13) , , , , , , , , , , , , , , , �q, ?1�5��•�� TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers unsler Sec.9116 (ax1.2)X.O�� ?1,500•00 15. 0•00 16. Amount of Line 14 xable at Iineal rate X.0 4� 0•0 0 16. 0•0 0 17. Amount of�ine 14 taxable at sibling rate X.12 �.�� �� Q•Q Q 18. Amount of Line 14 taxable at collateral rate X.15 �•�0 18. �•0 0 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. �•�� 20. Ft�L IN THE BOX IF YOU ARE REQUE3TING A REFUND OF AN OVERPAYMENT ❑ � $Id@ Z � 1505611285 1505611285 J OM4648 3.000 1 � REV 1500 EX(FI� Page 3 Ffle Number Deceder�t's Com lete Address: 21 13 0 9 3 9 DECEDEM'S NAME Y R R s�Er�ss � STATE ZIP PP - Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) � •0� 2. Credits/Payments A.Prior Payments � •�0 B.Discount 0•�0 Total Credits(A+B) (2) 0•�0 3. Interest (3) 0•0� 4. If Line 2 is greater than Line 1+Line 3,enter the difference.This is the OVERPAYMENT. Fiti in box on Page Z,Line 20 to request a refund. (4) �•�� 5. If Line�1 +Line 3 is greater than Line 2,e�ter the difference.This is the TAX DUE. (5) �•�� Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN"X"IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. r�ain the use or income of the property transfened . . . . . . . . . . . . . . . . . . . . . . . . ❑ X b. retain the right to designate who shall use the property transfened or its income . . . . . . . . . . ❑ c. retain a reversionary interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d. receive the promise for life of either payments,benef'ds or care? . . . . . . . . . . . . . . . . . . � 2. If death occurred after Dec. 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 YE3, YOU MUST COMPLETE SCHEDULE G AND F�.E R AS PART OF THE RETURN. For dates of death on or after July 1,1994,and before Jan. 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.$9116(a)(1.1)(i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the survivfng spouse is 0 percent [72 P.S.$8116(a)(1.1)(ii)].The statute does�ot exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax retum are still applicable even if the surviving spouse is the oniy 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 21 y�ars of age or younger at death to or for the use of a naturai parent, an adoptive parent or a stepparent of the child is 0 percent[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 beneficia�ies is 4.5 percent,e�acept as noted in[72 P.S.$9116(ax1)J. • The tax rate imposed on the net value of transfers to or for the use of the deCedenYs siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibiing is defined, und�Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. OM4871 2.000 RE1f 1b08 EX+(�1-10) pennsylvania SCHEDULE E OEPARTNENTOF REYENUE CASH, BANK DEPOSITS, �MISC. �r�E�R" PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Georae R. Shively 21 13 0939 Include the proceeds of litigation and the date the p�oceeds wene received by the estate. All ro oi�tl owned with ht of survivonhi must be dbclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH �• 2005 Pine Grove Mobile Home, VIN: GP46523ABAC; sales pric� 74,500.00 TOTAL Also enter on line 5,Reca itulation i 74,500.00 OwasAD 2.00o If more space is needed,use additional sheets of paper of the same size. REV-1811 EX+(70-09) SCHEDULE H " pennsylvania OB�ARTNBJT'OF REVENUE FUNERAL EXPENSES AND M�M�RITMIGETAXRETURN ADMINISTRATIVE COSTS �ENTDECEDENT ESTATE OF FILE NUMBER Geo=co R. 3hively , 21 13 0939 , „ Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FIHVVERAL EXt�ENSES: �, None B. ADM�VISTRATNE COSTS: 1. Personal Rep�esentative Commissions; Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 2. Attomey Fees: 3,000.00 3. Family Exemption:(If decedent's address is not the same as claimant's,attach explanation.) Claimant Street Address City State ZIP Relatfonship of Claimant to Decedent 4. �Probate Fees: 5. Accountant Fees: 6. Tax Retum Preparer Fees: 7. None TOTAL(Aiso enter on Line 9,Recapitulation) S 3 000.00 awasn�2.00o If more space is needed,use additional sheets of paper of the same size. REU-1513 EX�(01_,0, SCHEDULE J pennsylvania DEPARTA�ENrOF REVENUE BENEFICIARIES II�ERtTANC;E TAX RETURN RESIOEN'T DECEDENT ESTATE OF: FILE NUMBER: Geor . hiv 1 2113 REIATIONSHIP TO DECEDEfJT AMOUNT OR SHARE NUMBER NAME AND AODRESS QF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE 1 TAXABLE DISTRIBUTIONS[Include outright spousal dist►ibuutions and transfers under Sec.9116(a)(1.2).j �, Nsncy Shively 610 West Whitehall Road Stats Colleg�, PA 16801 100� of Residue: 71,500.00 Surviving Spouse 71,500.00 EM'�R DOLLAR ANI�UM'S FOR DISTRIBU110NS SHOWN ABOVE ON IINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. �� NON-TAXABLE D(STRIBUTIONS A.SPOUSAI.DISTRIBUT10N5 UNDER SECTION 9113 FOR WHiCH AN ELECTION TO TAX IS NOT TAKEN: 1. B.qiARITABLE AND GOVERNMENTAt DISTRIBUTIONS: 1. TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBIJTIONS ON UNE 13 OF REV-1500 COVER SHEET. S 0.0 0 8W48AI 2.00o If more space is needed,use additional sheets of paper of the same size. _ _ _ _ __ _ _ _ ____ Jun�251312:14p 310-417-8989 p.2 . . • . " . ...,,...... �.�.,..,... _�. WI LL � � � z, GEQRG� R. SHIVELY, currently of Mifflin Cou�tty. Pennsylvania. being of sound mind� ac►esao�ry and ur�derstanding, do cn�k�e and publish this �r.y Last �v'i 11 and Tes taxaant. hersby revoking and �a.king vofd all former Will.s by me at any �i� heretaf�re aeade. x�EM ONE: I direct a1J. m� debts w�ich �tay be 1�egally collecti.ble, and funeral expet�ses , ta be paid by my Executrix 1 hereinafter name�. ITEM TW�: All federal, state and other death taxes pap- _______ able because of my death, with respect to the property forming `v` .my gross es�a�e ror tax puiposes`, WL CVtiCt �i i�� rNs�-==n "n�� � t�is Will, including anp interest �r penalty imposed in � connection with such tax, shall be considered a part of th� expense of the adrninistsatiion of my estate and shall be pa�,d from my residuary estate under IT'EM 'TH�E without apport�.onmer�t or riaht of reimbursemenc. All suc�. taxes on pxesent or future inter�sts shal-1 be paid a� such time or times as my Executria o� Txustees may thin`K proper r�gard��ss of �ahether such taxes are then due. I�BM T�1R�E: All �he rest, z�sidue a�d remainder of my uwof�xs NOUCKWC3�NGp�CH �state, real, personal arid mixed of whi.ch I ahall d�e seize �5 N.�M�l�l@ SfAEE'f .o.eoxsso and possessed or to which I shall be e�titled at my deceas2. , �«nsroNn�.�.,��• . f Jun 251312:14p 310-417-8989 p.6 . - � � . ; �` w�.fe 1�IANCY SKIV�LY, gYO��ded I g�ve, devise and bequeath to m►Y . she suzvives me by thir�Y (3�} days. id wife is not living on �he thirty- ;n t�e event �ny s a res i.due and �i� �y death, I direct t�e reSt' f�.rsC day follo � estate be distzibuted as �ollows: Yem��deY of �y �.nE CWA.LTER AN'�O1�Y In the event any chiZd of t8� . RIL JA13�1�E '�1';�S� J�►iQEI.LE AP g�{IVELY► LORRAINE D�NISE SOI.1�, e time of �Y deatb is � LISA ARIA►L�tNE SKI'V�LY) at �h , . � LYNNE K�� � e, (2� living at Y g th� tk�irty �30} yQaYS of �� (1) les and C�+) a�Paxated from ,�� resi dence, (3) �emP�Oyed, curre hesei:'�af�er ��Ed ; use and!o= u�rried, �. direc� �Y his/hex �P� •dence and �ovsehold furn�slr���s txustees to retain rny said resi chiidxen ..�� � �� eccupa�ncy and use o� any °f �y �� therein "i-n kimd for without s o� this su�Paragraph (�7 • who rneet the YequiYem�t re�eive fYom �9' urther direet my said trustees charge• ; � in and nnaix�taininS said p��.UO �or eXPenses af keep � es tate �14� . no livi�S ��ild of rni�►g me��s reside�nce and furnz.shi:tgs• �w♦ 9 Wk�en � • w ,-at1T� ��� � ��a 4@�S P�� � nts of this su�p����y�-� t�e requixe� distYibute the • trtist ass etis an� • v�i dat e the �e�s o f sub� directed to llq • ustees to tie held under the s amo t o mY s a�.d tix' aragraph Cb) o� ttzis xte,�• ir�der o� p said rest, residue ��d zem� (b� '�1e balance of �o �Y txusLe�s hereinaftE �o���+ 8��, bequeath ...+.,r.K R GlisGAIGM },. Y a;_ve , devis e .,,a� i��e s�ment= ,,.,�......_ estaL� i �-- • in5µL�.. s�N.w�yNEs�� mY �o be �nvested in goverc��ae�t rJD'oa'"'0 e d Itt Txus t b �,M,s,owN,vU►.;,oea n� �� Jun'251312:14p 310-417-8989 p.3 . , r c�ildren o� m�ne who mee� the YeQuiYe- a�nd I direct any child o 1 be enLi.L�.G� �� s af subparagraph (a� .of this �tem s1na�. ment ra h (b} For use �nt erest fYO� the investnents of this subpara8 P e enses. ArY unused iuteres� shall m�oee aary. r_ormal 1 Lvix1g xP to m ather children equallq• In ��king be paid qu�=tezly Y uxiused iaterest nty tYU�tees shoul� such distributixan of �Y • d oz ch��.d.Yen W�O i��are reserv� suffici�nt funds foz sa�d ck�i� . re��iv�.ng i�t eres t f or neces s ary. narinal 1 iv3.n� expens es• . i� �ny�hir.g in thia ztem to t�e co�txaxy. �ic tw�.ths tand � lished in this Item sha�.3. ter�ctinat� when �Y the tsust es�ab ears of age at est living chi�d is twenMy-th�ee (23) Y y°�g rg�.a �n tz�st s�a�.l • 11 assets �ro� my estate being � whiCh t7�nle � � �, �a`� ,.t��i�d�Cen �� , rviceeds distributied zO �y be �iquxdated and the p ther. ta h�.$lh�r .. 1 or in t�e event a child is not liv��8 equ�l Y � : ,,,,.,,. ..QT �vr.irves • � ��su� �...+ � oint �Y ��g: Y no�ni-�at�� �onstitnte and apP .� ITF'M Las� �, a�d J A�T ELLE as trus tees un der t t�i s �Y d a u g h t e r s A P R� d trus t e e s f a s l s Wil�. and T�sta�t. xf oria vf the afoYenasne or ceases to act in such ���a��-t�' I nominat�► �o�'s���ute and bstitute txustee fo= s�1d �hild. appoint 'a�y' daughter LISA as su � na�inate, const�tute ana apPoint my _ I'�'�M FI.VE: Last Wkll a�d �eSta • t NCY SHIVEZX �� Executrix of� this my w+r�FU�s wtf e tiA H011GK�(ilN6AtGH In ��e event tny s a�d �ife fax�s to act as saxd Executxs.x, j¢�.�w►,���Y ment. o o in t �y daught ers AgR�I, and �A.wo�.�a �p�stitt�te and a,P ; iew��rowN,��.,�tw I AoYa:►.nate: , /' . Jun'251312:14p 310-d��.7-8989 p.4 . • •• . . . ., . ... .. . . d • e �xec�strices. If vn� of the aforena� � J,�L� as substitut substitute Ex�c utrices f ai�s oY ceases to act in such cspa��t�', ,I nca�cinate, can stituze and appo�.n� rnv dau�ht�= LISA as substitute Egecutri.x f oz said ch�.ld. ITEM SIX: Y direct t�at rny Executrf,x, trust�es or the�r � �ve ���CS'� f4r the �sithful successors shal�. not be reqvired to g - erfoYmancg o� their duti�s in any ju=isdiction. p ' but not 1�ited ta I'�EM SEVEN= �3o i�terest (:Lincluding, a}1 shares of �rincipal an,d incame) af any benefi.ci.arp under this �il� ar any Codic i.l he=eto shall b+� subject to antici�ation or volutttal'Y' or invvluntary alienatiOn. he even.t ariy b��efic�ary af niY eS�te is ITEM EIGHT: In t esta�� ears of age �t the ti.me hel9�e shaYe$ in my -.., 1ess thax� 18 y I ive, davise - other trusts herein. � � and is not covexed by �Y aforena��d ��st@65i ` and b equeath sa id benef iciarp�s sha=e to � � � terms and �o�d��io'ns: Iri 'T;rus t, up on tY�e f o 1lowing txu s t s, he trustees hereinbefore na�u�de��he A. Said �haYe to t owers and du���s foz said benef�.c�-ary with the P $ra r�ph B• � � terms and conditions set foYth �n s�b-p 8 �ollect the re�invest �d �ng�e' xin�lpal af �. To ha1d, invest, and so mnsch of the p �ncome►, s�r.d use the it�'�g e s� ��xt, � as �.n the solc artd abso1�or th cYepiott a �he txust estat be n,ecessary o� pr�F�� said trustee9 �Y g� s�gical �d �ospita1 needs o� maintex�ance, medic . car e. de sa�.d beneficiaxy• � oses �9 be � �rdia C. The paYa�ents for the�$hou��he �ntetv'ention °��e cur�ent �y ��e trustees diYectl.y, w�.t 89 ���•, of rustees ms.y pay to said bex�ef iciary 1'1cie t . rincipa�- as t�e trtYSLees in thei v►wo�,c� income, accu�aulated �ncome or P HoucK a�iN�aicH �s r�.w�►rNE stl�* PA.eox•�0 ` �gTOwW�pe.t�O�a � Il , Jun"251312:14p , 310�17-8989 p.5 V �• . � � • . � . •1. ' . �. . . �• •1�'.�• • �. . . V . .r•v IIt...'1- . � . •. absolute discre�io�n deem advisable for ttie suppoYt, g°1e a�d of said beneficiary• �n $aid educa�ion an� weil-be�tt� neficiary reaches the age o� �.g ye��s said txustees are be the re�inder of the direct�d tb paY to such beneiic�ary ther with al� accur�x�ated �ncot�e �d o fl said t�us t tYUgt Cog� rocee shall be terra.inated �d ��nt�to�the�intestate la�s of �r" sha11 be d�str�buted pur roceeds of y . .,��o�-t_ In t�e Qvent the p �,�,��;��$£ore 1 sylvania tn�i� i� � "'""'aid ovex to t�e tru����s .. y - insusauce pa�.icieedsr ha11 be hel.d by the t�st�aa�this Will, n�gd, such proce sa�ae trusts, ter�s and �Or`�ti�de b atihe insurance cor�pany aa and as re�pect to any Pa�� s�all e u�de�r n= e�ob�Che tYUst ta szi.d ti'ttsteeS��nsible�£oxyChe gropeX discha $ see to or be xesp - � such paya��t to said tr�3���,�e all o.r any part thereof � and a y unt so paid; a �u�,ly d�.scharge the con�Pan� for the a� S ate tz�s.st cc,�oapany sball nat be char�;ed with not��iss�seSOZeChe termi�az�Qn instruraent, the death ef ��id�Cel thereof i s recoived at �ts o� a trust utitll written� hos�e office. D, ;Ky trus tee s sh all be .cQ�Pensaze� i� accordPennap v��-a hedule of rates,in effect in �in�wh�.h heix sez�vices are the sc t�e p�rlad f xont �i�� to t ime duz in� rendered. E. �y t�ustees sha 11 invest in governmer.t �nsux�d invest- tner.t s. � e rincipa�. o� ��is tx'�st be ar b�c�e �o �, Should c� p. discret�or so as �o �ake continu�nce sma�1 in �he t�stees �� mg t�stees �Y' �ke ��edlate dis- a f the trust inadvis ab ' rincip�� and anY accutaulated tributioj► of tihe then-sar�i��-n� p �gons �X etttitles Up� Che teratina- or undistri.buted income axe�then�ent�tled. .ge }�ave an in the p=�P�rtx.ons they gr$ons c�ho �g�t other�� tion the rigk�tis of al�. � or as xem�ainder�n ' teres t as succeedzn$ i��o�e benef ici.ary �n sha11 ceas e. ���,y� the Tes tato�� �a �� WIT�ESS �HE�tE�F� I, GEQRGE R- seal (to thi and �estaraes�ti� set my han�d and to this t:�y �.ast Wili , 1.98�• u�w ocf� i.n strumex�t only) this ���day of /��� }�OVCK a GtNGRICH (S ,a s�.w+►w:�rn+��T pA.90x� 1 ���N,pR t 70µ �� : ' Jun`251312:14p � - � 310..*ti-17$989 p.7 . . .�- ' . .,� _� , •....1-.._. . -. .� ....M�..wt��rr.rNd..�. �.vi�r••.1Y.�.�MlSK17MfASA.4:r�•'�"s�'1��•V N��••��S't+..a , •rw.. ... ..<..vf • • � •.. . � �r. . ,,, . d ublisY►ed and d�clared by �t�ig above-nat�ed ��.gned, seale , P , VELY Testator, ,as and for his Last j�ill and Testa- GE4RGE R. SHI , the resence of us whv have heYeunto st�bsarib�d our ment, � P . es at hi�s request tt�exeto in the gzesence af the said nam� T�stator and of each other. , . � ; ��� .c�-� ,�.� � ��• / '� �: �I� �� • �. � I * `��� �+., 0 t.,�,,'y"t �r � , ` 1/1W O�`'IC�' NOUGK�►CiING111CN Tb N.MIAYttE 61riE�eT r,0.NOri'� . Mw�S'oWN.M.�70�� + Sep 1311 01:25p Sola ARCHIBEn'��t� 31��'i?8989 p.2 , . LOCAL REGISTRAR'S CERTIF�CATI�N OF DEATH • WARMtNG: It is illegal to duplica�this copy by photostat or pho#ograph. Fee far dtis certificate,S6.Q0 ,,�� Thi.� is to certify that the u�farmation here given is ' ��c,�`����Q�pfiY,�. �om;c,,dy copiod from an originai CertifiCatc of Death �l► � ._:� .="::. J',` o r duty fi�d with me :ts Local Rcgi�rar. The original a�. � ,'� � certif�ate will be forw�warded to the State Vital ��, y - j�► Recotdx Offioe for p�tmanent filing. * • ,��r � P �.7652431 �;� ;;,,,. ;. 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C:C4ABS�C�'p11GLE , GEOf�GE R SHI�ELY .. . . . . � . � """- '``�`''°``"�'�� 8 rI�H71�L���'�� -._._�.�. . _..�— - -a P���•� SHIPP�NSBl1R� PA 1?257 � . � ' . "_'�°�"`"�"� � ���� P.�lWp$A lQ.lOE�'E►�CLE A o REOOItiTIM.CTiO e s BTR�T qOq 7-i�GCY6Rt0 T11l�RT�� � V:�ilQ.t COVTi�rN!i�6S.JFD V M • W=ROOD N�'1^�.L! X=ISAAI�J1'•`A%� PIFE"1JB'�FAVOP.OF' SE�COZD LtHd FAVCR OF: N a samd faAoktr k ls�d�roon atlCaqWn �ttr 6rsl Mn, 1!r list BenholdK Rw'�R brws�d�'k TAs!c t�e 8r'�au d GWO/VMfIC1t3 wN�tlis FriiST LIBV AFlE+.Sa+" ' aPP����dnn a�d fo9. DI�7E eY SECOND IJ9�1 RE�J►S� 1WrF10RRED R�P�FSF?ITATIVE �T� MIW,JMG 4D�Rfi53 BY RU7MCRlLEO iiEPRESEKTATIVE G�4RGE R SHIVELY � 18 nICHAEL CT , SHIPPENSBURG PA 1?257 ALLEN D BIEHLER ' �1 c�'�Y rs a�R+^car d:sa:a.tne e!e:al nxros cl tAr.Pc*+�+:a�a D�?'+�'+�K -- �rsrrii�ior(�tton rMsa a"an1iD o.�•�(aT b aaRprr�nlli+�al�si.h r e1N tlWk►ewrNr•-- — -- -- ----- -- •.. .. d M�aid v�ltlslt ��� � � � If a co�urchaser ofhtr�an rour cpouse�lst�i sed yau w�rU ihe tib�- suB6Cw�A�D Swotan } be Usfed as"Jofrt TensrA,s W�h Fti�t of Suvivas�ip';Or deelh of on� �o sE=oaE t�: o„r owner,title goss to sunki�p owrer.)CFIECK HEFEL].dM�erwise,M»tl�e wW ba Iss�ed as'Terar�s in Conu�w�'(Cn daeAh d ona anrnsr.�n1a�s1 ot . deoeased cwrwr yoea t�his7�er ne�s or eatate). sww.tun_cf�rs�p++o�+dat�ar�o+r- t 8T�EN OATE. ♦ �=ND L�.d�EGt � � 15T LENHOIDEH 1 STFEE'f � F Cny STATE Z� � �IF TNl6 fB AN EL7,d'.ECK Ml�iff�"'I =NNYCtAI NC�E:RN I�UIRED L--J NsitMtGN N0. A 2NG L.EN QATE: ♦ IF N4 U�1,CHEdC � � �a w+Awi7��f mius•:ok�ar w c.itlrrs.a a Tfa u Ts wi+W�.,rar�e �1 y�wa srbryc ro tha�nartY:ares ad aFar Ngti crm�ca Y�M hw �21�UENiOLDER __._...... ..�./ �"�' �sraEer � � Si(tK1TURE QF�FN.�CAV'Aa 3UTNQit..'GO SIf�Ef1 r � � ��m &7ATE ap � :�-.�S�.��.T.�M�D �',��. s�ur.�nea•CC•r.w�[anzT-.t_t•�=+Cs:Z�aS•S�.t• �NOTE: NREO!!� 1 1 #ya r' � , � t " • ' �� ' � a' �J . • ��� ������ � � � ��w���• •��������w"'��.�r������������ •����i�w�N���M�������������N/��MH � �N�W�����N��M����n������►�H�����w���������♦ ���.��������������I� � .. . � � � � �� ���� �� � �ed' ''!F c � ' � ��'�I�i te m■�o��NI�����IQ�MI�s��t�wed aw�lprt ��d�IiM�b11��I�A����ifi������s���i��1MI�i11�i�!l�IIR�� , f. s�id�af�e�cprta�n�ts���c��t � Z�'e►��� �� s�r/es� �.�ll ,drrj►/�a�r�.� /��►e �'`r+���, �rar��� . p,¢��"'�.� �/�� �� jr�.- ���'" �Ee.�� re ! �. 1' �o �.r/ � 1 : �s"'r� �. . ,��� ��u.��;� ����- �� r �, � �R ���.• � �� .�te,� 7"�•��'�%�rc.�If��,•���� / I� �ud�M�of t�e sraawd prt���t�t1t�i: �s,f� �� ,0��S' �°',�k�'��C o'�� ���� o� f-�r'� �;�►i✓6�r! / • ' r��; a�` �''8 �+9�r�i�BL ��` �`'o t�r.��a� �r,r�,s' r s'a� e��'/�►° � 1�' � i/ .� �,.�`��,�� �frl�a .�'o d� �� e�lS`�� �'� d��''y�� x�'. °v �I'�+l ei+r s�' 9' �(ar�� Ot7�'ade� ,..�. ���� syr� ��"'� �, c�Ma��o�at�eaby�aiir�l�wra��e� • . p .6l� � �� �f�sa.�c� ,�,�L.. ��af.rwt� �� a�' •��'''�"�``� .�/ , /� ��`��, � w.rs��� � �� ,r��i � �� :� �� ��, �'` y� �r� �tr�'`d���j��' �� � +�les�`�✓ m�r Dc�a`� —�—��.1.3� �`�e�' � s��'r ���e�' �'� o� � � ����� ���� ��t'�nl',���I, �,�ra�1�s�i,�sroA�a �aoe on�u� ���e�� �����t�tabo�ewr� 5i��ed In1�pe�r�e°i' �t!�: MM�ne�: SeG�Ad P�l1= ' r � alo/�t..w•M�"! .1w1111�� • 50/b0 3Jdd lladW�t�Hd l��13H l� �9z6ZE5LZL Zt�0t �ZOZ/9t/0Z Vv � rv � V �� y � � Law Offices of � �C j�(� � ��� 2109 MARKET STREET•CAMP HILL, PENNSYLVANIA 17011 MARK E.HALBRUNER (717�731-9600•FAX:(717)731-9627 CRAIG A.HATCH,CELA BRANCH OFFICE: Certified as an Elder Law Attorney by CORRESPONDENCE ADDRESS: 3 WEST MONUMENT SQUARE,SUiTE 304 the National Elder Law Foundation Camp Hiil OffiC@ LEWISTOWN,PA 17044 CLIFTON R.OUISE WEB SITE: (��7)248-6909 Also Admitted to practice before the www.hhglip.com STACEY L.NACE U.S.Patent$Trademark Office Paralegal JOHN H.MCCULLOUGH TRACI L.SEPKOVIC Of Counsel Para�ega� TRACI L.HILFERDING Paralegal November 26, 2013 FEDERAL EXpRESS Glenda Farner Strasbaugh,Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 RE: Estate of George R. Shively File No.21-13-0939 Dear Ms. Strasbaugh: I am enclosing a Pennsylvania lnheritance T�Return, Inventory and Sta.tus Report for filing in the above estate. Please date stamp the extra copy of each document and return them to me usmg the envelope provided. Thank you for your assistance. Sincerely, � - a� ace Cl��ace . Y Paralegal Enclosures cc: Lisa A. Myers, Executrix � � �v � Q � � m � � av �= � cc;� � = ca � �r' � �'7 � �- N � � � � �rn„ --.� '� � �7� p t� �7 t a � �' `t� "r� C 3 � � � � � , , f-.. 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