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HomeMy WebLinkAbout01-21-14 � 150561�101 REV-1 soo EX�o�_�o, �Y� �: OFFICIAL USE ONLY PA Depa�tment of Revenue Pennsylvania ^� Bureau of Individual Taxes �FO�M:MEkfOi NC:VGNUE COU�I�CIJU� Year File Number PO BfJX�8o6os INHERITANCE TAX RETURN Z 1 /3 ���? Harrisburg,PA�.��28-0601 RESIDENT DECEDENT _;_ ; �� ENTER DECEDENT lNF�RMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMODYYYY ' 05/06/2013 ' 03/05/1931 ...... . _ _ ___ . __ _ _ _ _ ___ ____ ___ ____ _ Decedent's�ast Name Suffix DecedenYs First Name M� _ ................. . ... ... ..__... __.. _ __ __ _ _ , _ _ _ _ ___ _ ;_ , SI-�EAFFER GAYLE ' K ' (If Applicabie)Enter Surviving Spouse's Information Below Spouse's Last Name _ _ Suffix Spouse's First Name _ M�_ _.. _ _ .. __ _ _...... Spouse's Social Security Number -- THIS RETURN MUST BE FILED IN DUPLICATE WITH THE _ ____ __ _ _ __ _ . REGISTER OF WILLS FILL IN APPROPRIATE OWALS BELOW (� 1.Original Retum O 2.Supplemental Return Q 3. Remainder Return(date of death prior to 12-13-82) p 4.limited Estate O 4a.Future Interest Compromise(date of p 5. Federal Estate Tax Return Required death after 12-12-82) � 6.Decedent Died Testate O 7.Decedent Maintained a Living Trust 8. Total Mumber of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(date of death O 11. Election ta tax under Sec.9113(A) between 12-31-91 and 1-1-95) (Attach Sch.O) ,�,, CORRESPOMDENT- THIS SECTION MUST BE COMPlETEO.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMA SHOULD BE D�TED ` : � . ' �. .:. Name Daytime'�e{�ne Num er � � � _ ___ ;THOMAS E. FLOWER (717)7�,,�-`�'I� � � �' ' ....� � _ _ _ �a �,,, r..,. � . RE LL�SE O�Y� � � � #"�r G.�' � �„j � —�y "'r� "�'1 First line of address ___ __ __ � � '�"� "'� � . .. . ....... . ...._ _ __ _ _ ___. ___ __ "'r'! _ _ «.�-i ~' f"�'"' f�f FLOWER LAW, LLC ' _.. . _ _... __ _ ___ _ __ _ _ _ ,� _ � � � Second line of address � 10 W. H1GH STREET City or Post Office State ZIP Code DATE FILED CARLISLE ' PA !17013-2922 Correspondent's e-mail address:TOf�A�FLOWER-LAW.COM 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.Decla 'tion of than the personal representative is based on atl information of which preparer has any knowledge. SIGNATURE OF RESPO E F FIU TURN DATE ADORESS SANDRA K. SHEAFFER; 1 HOLLOW ROCK; LINCOLN UNIVERSITY, PA 19352 SI A OF P T R THAN REPRESENTATIVE DATE 41/13/14 ADOR FLOWER LAW, LLC; 10 W. HIGH ST; CARLISLE, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 � 15056101�1 ],505610101 J � 15�561�105 REV-1500 EX Decedent's Social Secu�ity Number oecedenrs►vame: GAYLE K. SHEAFFER ' 200-24-2356 ' RECAPlTULATION _ _ _ 1. Real Estate(Schedule A). ................... .............. ..... ...... 1. 240,657.00; 2. S#ocks and Bonds(Schedule B) .............. ............ .. ........... 2. _ ; 3. Closely Heid Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. ; 4. Mo�tgages and Notes Receivable(Schedule D}............... ........ .... 4. ; 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. '; 43,259.16 6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. ' 7. Inter-Vvos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. ; 8. Tatal Gross Assets(total Lines 1 through 7}....................... ..... . 8. ' 283,916.16 ' 9. Funeral Expenses and Administrative Costs(Schedule H)............. ...... 9. ', 28,427.81 10. Debts of Decedent,Mortgage�iabilities,and Liens(Schedule I)............. . 10. ' 14,710.45 ' Y1. Total Deductions{total Lines 9 and 10)................................. 11. ; 43,138.26 ' 12. Net Value of Estate(Line 8 minus Line 11) ....................... ....... 12. ; 240,777.90 ; : : _, . _. 13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) ..... ............ ....... 13. 0.00 ; 14. Net Value Subject to Tax{Line 12 minus Line 13) ....................... . 14. ; 240,777.90 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or __ __ __ __ __ __ __ _ transfers under Sec.9116 ' (a)t1.2)X.0- , 15. : : _ _ . _.. 16. Amount of Line 14 taxable at Iineal rate x.0 45 240,777.90 : �g. 10,835.00 ; _ . 17. Amount of Line 14 taxable at sibling rate X.12 ! ' 17.' __ _. 18. Amount of Line 14 taxable at collateral rate X.15 ' �8•! 19. TAX DUE ........ ....... ....... ................. .............. .... 19 ' __� 10 835 00 � _ _ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 � 150567,0105 1505610105 J REV-1500 EX Page 3 File Number �t � � I _D��� Dec�dent's Complete Address: S DECEDENTS NAME GAYLE K. SHEAFFER ........ . ...._........... ... ........ . _ . _....._ ___ __ STREET ADDRESS 7 COUNTRY CLUB DRIVE MIDDLESEX TOWNSHIP __.. _____. .. __ ____ _._ __ _ _ _ _ ...._._. __._ _... _.. _ ssATEPA _ z�P17015 C CARLISLE Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 10,835.00 2. Credits/Payments A.Prior Payments 0.00 B.Discount 0.00 _._. _ _ _ 0.00 Totai Credits(A+B) (2) 3. Interest �3� 0.00 4. if Line 2 is greater than Line 1+Line 3,enter the difference. This is the OVERPAYMENT. Fill in oval on Fage 2,Line 20 to request a refund. (4) 0.00 5. If Line 1+Line 3 is g�eater than Line 2,enter the difference.This is the TAX DUE. (5) 10,835.00 � � 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. retain the use or income of the property transferred:............................................................................. ............. ❑ X b. �etain the right to designate who shall use the prope�ty transfeRed or its income:............................................ ❑ 0 c. retain a�eversionary interest;or.......................................................................................................................... ❑ 0 d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ � 2. If death occurred after Dec.12,1982,did decedent transfer prope�ty within one year of death withaut receiving adequate consideration?.............................................................................................................. ❑ � 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ 0 4. Did decedent own an individual retirement account,annuity ar other non-probate property,which containsa 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. .�. �t...�'�r�a'°^��'��c�,�p��:.4� z�� �., .r < .,. ... ����.... ����'��... .. ....: ....:.:: r> .<,:>...Jr.,,:�'� ? >...:.,> :.:: .. <: .. . ,, : . . � . . . . . . . . r � x 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)(ijJ. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or far the use of the surviving spouse is 0 percent (72 P.S. §9116(a)(1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax, and the statutary requirements for disclosure of assets and filing a tax retum are stil!applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: • The tax rate imposed on the net value of trans�ers from a deceased child 21 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 percent[72 P.S.§9116(aj(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 percent, 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 percent[72 P.S.§9116(a}(1.3)].A sibling is defined,under Section 9102,as an individual who has at least one parent in comman with the decedent,whether by bload or adaption. REV-1502 EX+(11-0$) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIQENT DECEDENT ESTATE OF FILE NUMBER GAYLE K.SHEAFFER 21-13-0587 Ail r�l property owned solely or as a tenant in common must be reported at fair marlcet value.Fair market value is defined as the price at which property wouid be exchanged between a wiiling buyer and a wiliing seller,neither being compelled to buy or sell,both having reasonabie knowledge of the relevant facts. Real property tha#is jointly-owned with right of sunrivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. �M Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1� DWELLING HOUSE AND LOT,7 COUNTRY CLUB DR.,MIDDLESEX TWP,CUMBERIAND :COUNTY TAX PARCEL#21-17-2694-017;ASSESSED$201,900 X 0.97 C.L.R. 195,843.00 2. 0.76 ACRE UNDEVELOPED LOT,CIRCLE DR.,MIDDLESEX TWP.,CUMBERLAND COUNTY TAX PARCEL#21-17-2694-017A;ASSESSED$46,200 X 0.97 C.L.R. 44,814.00 TOTAL,(Also enter on Line 1, Recapituiation.) $ 240,657.00 If more space is needed,insert additional sheets of the same size. � ��� �� �"��� �� � ��-��= fl.. � 5 i��i�i ,�I�i�ti�Il� �_ (lliiit`, , �', �, � \ �� � � 4 V �° "� � �"1 ���'�E?� SE'�i=�,�,�� ��� �� � � � :x.. �.. .... ;� t� �" t � ,. {1 �a [-. � . . ��1�_1� L�� ?� �_ .. _- +�,,;..i..t�!a . ._ � 7 , � }� � _ � _�...�,_J l.� � �" ''` ` ����' �� �) _ � �> s�`.:��l.,l � L.,"i : i #�" ... ����1 �4 ��;�_''_ , I. � � x �—a ��� I � t:a . . _ .� C{�►��T�.� ��,�� ���� � �: �� i , � � E _�,� - g j f � Y . C.._. _i M ?- i_. 1..�_. -+ . � . 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'�L`��:�ici����ty: NIIDDLESEX T(JW NSHIp i�.9; ,,C��'!�.� i�`i ��C)�l�S . ;� ;..,�.° (..�� ��'�E'{�I i1(� . l�..��c�� i'�' �X�E,'�`IUC: � :zt ;:�f��, : _-,� ��ercentage � ;a �_ � r � ac.. . . ;`'-i l�.?y''!��l o�!! 1 . 1�.j � � ,���i � � �o��"��S : t:����.� ����t�r�s ; �����!� ���_�� a �-�r=:a �� �3c���� ' REV-i5o8 EX+(il-lo) ennsylvania SCNEDULE E p CASH, BANK DEPOSITS &MISC. OEPARTMENT OFREVENUE INMERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: GAYLE K. SHEAFFER 21-13-0587 Inciude the proceeds of litigation and the date the proceeds were received by the estate. All property jointiy owned with right of survivorship must be disclosed on Schedule F. �M VALUE AT DATE NUMBER DESCRIPTION _ _ OF DEATH �,' COMMONWEALTH BANK CHECKING ACCT#1691018368 28,425.29 2, CITIZENS BANK CHECKIGN ACCT#892-7 9,966.55 3. 'HIGHMARK,SENTINEL&COMCAST REFUNDS 494.34 4_ PROCEEDS,YARD SALE OF HOUSEHOLD GOODS AND AUTOMOBILE 4,373.00 ' TOTAL(Also enter on Line 5� Recapitulation) $ 43,259.16 If more space is needed,use additional sheets of paper of the same size. ������ ��������w ����� #s�P����i+��r��tarr�;�t�rr�ntltr�u a����i����f�r�D.���°r�t irtt�r�t r�t��i�c��t�t vuit��-P�y,�c�rtain m�t°tg�ac�.T'� �x�}�v��ff���i��r��y���rt��c�n��1�'�ti��r�€����1���e�k�.�c��.����f 1t��� i�ft��i��g�.���3, �Q13.�+u arre e�'��f���,�* ��f���ar�c�rtgat��:�?�ir��c{xt�.Talk�vit��rr��rt��c��€�fes�+r���l i�t���������r�t�����t�r�t�disacc��ni uvt�i�it�ts� �1�isit y�ur iocal bra�ch � "�,877.768.22t55 �' �t�+ere��nbat�c.c� wMMli E d I4k M,�S ¢`YZ �.?L � i �;yx, g w ;:�a �f-u 'es`�i F ...x,r yf �s�...,�� . i �.# . ��., .fsn'k'a ih•;:. ��.sz.s�sx i d°fF.t?�Ys�Y"',+.!!?.qkP°iA aTY+ktJb�?QE".�yt�fRt i`I,C�.;1�.?� <yxk a (.d..�.'�s >;,k.' 3.,2 .4..� ..,c• r:v� s 1� y .n�» rrol,:j+a xf� u. nE 5¢ .anfi L mtK.�k3l�'d P iFi�?;lfP1,3°5 S��R�89�e�lASfi���'� »r :, ye;.s•�� a; )e.a �:>.Y. tta Y z# .„o. �,m�s t.;.;5 , .....':� �.'^:..;: "£ s.,..,..� <..�-: �.r.f.�., 4r�:;: , a... . s.,y��o1:"hR:�"a` .� d�` i . .:<. �` > vt, h,.:::R`<P. .....i. 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C ���h�it#�j Pt�sb�d=tw81�.� Art asterisk{`j i�ic.�tes��kip in�s�qu�ntiai rheck►�umt�r�. An�E)irsdicat���h�ck wa�t�t�ve�lcd i�an+�lec#�ic i�err�. �it�NJIRt�AC���` �t� t�we���ia�n 14ct�liona �►usbt�+ctiwns � �� . � �8��25�:�A t15i-1'� _. ,fi�#E�K_ 1 . 1�3tT19' i1t�0.tK} ;�•�" if�t�i �i'T�CARD�',YM��'��C�C R'��utl�t3d515 �1t�t?,8t} 2�',�` -�+ �. . z > :;: �:; �. � . ; .. . C!5-tf +r�B1�E.f�'Y'�!'t'f�t3a153i�i� 37t.f� �7611�� . ..t � .. F .' #.kRk .- �;�^K'�yfkY Y}�!, f E .. ��tf � S s:.�'kt �,4 S'y� Y " 'Yi. •R�:.�.,,.' :$� ��'�`t►,r�` �+��i��,l�.��` �������� ���� state�t c�c��nt ������� ��� �aU�f�.,�n:�'Fl��r�B�nk��+�in�+e fa� #�"'C7�-+#� ��� ��c�v�#irrf�rmra�is�r+,cu�r�nt ra����d P`t�dW�t�B RI� �€�sw�r�t���e�e�on�: � �� � B�it��ri�� Ma�t 0�.��13 t�rc�u���un+�3;�,�#?13 Jk7' t�1 t?���t�� �F'�t1 � � A''"��T �������������������#������i�����1�.�����:������lr����l���������#�� �A���c�����:� � r�r�..�.c�v���c�. LtAICC�l.1��I�I�fiER�IT`Y Pl�1�3�2-�94� __ __ _ � ����1't� _ _ .._ _. _. : �i 5��9 1 1 ..�... � � _ �. ��i�x�t R� �AYL�K�EA�F�R �. 8���t�W�t�� ��t t�i� ��1C�92-7 ��ts;$�t�1��� �,�"i�.5fi �h�s .t� - Withidrawals 18,���,1.7 .. Cl�p�s��c$l�drlit��r�s ��.��. + �ua�� .� � :� � ._... �o�ca�w�iv�e�te�t��t�lat��nair�n��c� �e c��5�.9�l�y m�irtt��n�r�� an av�rage d�ity t�a�t��nc�in ■� y�aur�ac+ct�ut�a��S"1,��0 t�r m�kir�g�q��l�fyi��txansa+ct�i�ns. --� Ycw�av��tge d�i�y b�tarrce use�i t��uatil`y fihfs st�t�rn�nt p��is�d is: :�#�.1�3 Your numb���f t�alt��ng tra�nsa�t:3��s t.�i� stt���m�� �r�c���s: � ---- �s�e 1°R1�115ACT1i�lt DE�`14�i.5 �,��'.�� � - _.�. �''W'�'��fl�,i � � � �� t��t� �4,�t�.17 �ta��r�g W�rawa� � ����s � 1�,��17 t���JI�i� � � �� t��3 2�=�61. A��Ir�B�ni�t�ym�73�3 t��t�2a��� __ � Ta�k�c i� - �.� �... �4F2.�1 � ��� p�8�e �..�' �� Q� � �i�e Il�te t�ssi� �a��rs �Gj�3 10,Zt}�3.�7 ���75 .Ot� �E�t� --X��c�u h�ve�a�d�r�r���r Ir��ut�t�i�nt Av�itabi���a�tds��,. y��uo����t�n����em��t i���d��table t�at�ttc��rs T��.at tJ�erdra�F� a��d T�t��R�tur��d i� ���, t:����ny r�ba�.y��pai�i f�r t���t�metr� pe�it�d ar���?��'�h+� tal+�dar year t��at!�. �r�ns��it�n d�ip�aEnrs�tx f�^s�a�d in T+�t t�€lr��fi F�in�lu�"th�+�rdraft F�"an� "5uxc��r��# t�rt�1���.�r�tn��ns�ab�t�d"`T�t��i�t,�var�l�bt��unds�"�e�'ar�ir��i�ded iz�T+�tat �t'�+�'!��F+�s� «�.r��,� � �aaw►�o t� , REV-1511 EX+{10-09) � pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER GAYLE K. SHEAFFER 21-13-0587 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' HOFFMAN-ROTH FUNERAL HOME,TRADITIONAL FUNERAL SERVICE 4,850.00 2. CASKET 3,060.00 3. OUTER BURIAL CONTAINER 1,620.00 ` 4. LETORT CEMETERY,INTERMENT 900.00 5.' DEATH CERTIFICATES($30)AND OBITUARIES($600.22) 630.22 s. CLERGY HONORARIA($100)AND FLOWERS($159) 259.00 `. 7.' PILLOW 2fi.50 6. ADMINISTRATIVE COSTS: i. Personal Representative Commissions: Name(s)of Pe�sonal Representative(s) Street Address __... _ ..___ _ _ _ ___ __ _ __ _ __ __. _ _..___.. City State ZIP Year(s)Commissian Paid: 2. Attorney Fees: 10,000.00 3. Family Exemption:(If dec2dent'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: 413.50 5. Accountant Fees: 6. Tax Return Preparer Fees: �• PUBLISH ESTATE NOTICE,THE SENTINEL 227.45 _ __ _ _ _ _ _ . s. PUBLISH ESTATE NOTICE,CUMBERLAND LAW JOURNAL 75.00 ' _ s. SCOTT LAMPETER,PROPERTY MAINTENANCE/LANDSCAPING 1,610.00 : '�o.` 2013-2014 SCHOOL DISTRICT REAL ESTATE TAX 2,396.35 . ��. ENCOMPASS INSURANCE,FIRE&HAZARD POLICY 1,630.00 '�2. :CONTINUATION SHEET TOTAL _ __ _ 724.79 ` TOTAL(Also enter on Line 9, Recapitulation) $`' 28,427.81 If more space is needed,use additionai sheets of paper of the same size. SCHEDULE H CONTINUATION SHEET ESTATE OF FILE NUMBER GAYLE K.SHEAFFER 21-13-0587 1. PPL,electric service 238.54 2. Middlesex Twp.Water/sewer 157.50 3. ADM Electric, repairs 85.00 4. York Waste Disposal 243.75 Continuation sheet total: 724•79 � N ,, ,f���* �� '�� F� j � . ..� ..� .' �. . ... � � . � . ��������..�� �,���'�� �c�'' ��.�.p��,�.� �.��.��t ���.Y F �����t�V�� S�n�lt°�Sh��!r 1 H�►�r i�c��C I.�r�IJn�ver��, F'A��35� _ S#�t�t'+r�srtt r�f Fu�cer�l E�c�s��f�r: t���±�K. St��af�er i�rte�D�h. �y�,�t��� �cv�nt�d. 1�87!B-1�t 7 ���'.y!�i. .. . . .. . ... .. .. . .. .. . ..... . ... . . �'�d�t�a�Fungr�t S�et�� `TR�ifi1�3[�!.F�lNERAL SE�t/iCE Pr0.�1�A�E $ �,��tl.�lt} �u�Tt��: $ 4,8�.4t? M�R�A��: C�k�t; �.ai�esh�r�a 11 � 3,D�t}.aQ t'�t�ter�vr�'�i�r�: Nha►�t#it:�lka $ 1,�i�0.Q0 ' S►�t�T+�t�i: � �,+�.�t3 TQTAL.�'Ut��R�l.Nt31��GM�IRCES: $ ��53t�.� �A',S'r�1�t;!'�,�E1►iG��i: l.e�rt Ce�et�ry � 9Q��,t3� , 5 C�rti�d D+�t��ertif��t�s$t�f.t3t?ea+ch � 3�.t}Q �l�s�per�+i�t�-�n�n�t 2 d�y� � 3�2,�2 I�ewspaper I�Q�e-Md Pa�er 2 C��ys � 2�.OQ C�y � 1 t3�?.Qt} F�t� � 1��.CtCI Pi1� $ ��.�Q _ �ub�'�H: �► 1 '�3,�`� _ �'�!�u����x�e; � �t1,3�4�.7� Ray�rr��IY��rde:; Ba��nc�: � 1 i,�.?Z �A,,'.,.'�,� . � �` � �� Y � . '� * t��, r � f X� �. �:.. � �� 1 •�� i:. 'F.. ,� .: �'. � �� � REV-1512 EX+(iZ-Q8) � pennsylvania SCHEDULE I �EPARTMENT OP REYENUE DEBTS OF DECEDENT� INHERITANCE TAX RE7URN MORTGAGE LIABILITIES &LIENS RESIOEM DECEDENi ESTATE OF FILE NUMBER GAYLE K. SHEAFFER 21-13-0587 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medicai expenses. ITEM , VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1� 'AT&T CREDIT CARD 2,263.36 2. DISCOVER CARDS 2,395.67 ' 3.`' BANK OF AMERICA CREDIT CARDS 5,339.26 4. 'CITI CREDIT CARDS 1,566.13 5. 'COMCAST 91.68 6. CHASE CREDIT CARD 813.00 7. 'PPL 33.32 8. LEFFLER ENERGY,HEATING OIL 264.84 ' 9.; 'CUMBERLAND GOODWILL FIRE&RESCUE EMS,AMBULANCE SERVICE 1,943.19 TOTAL(Also enter on Line 10,Recapitulation) $ 14,710.45 If more space is needed,insert additionai sheets of the same size. REV-1513 EX+(O1-10) � pennsylvan�a SCHEDULE � DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT OECEDEIYT ESTATE OF: FILE NUMBER: GAYLE K. SHEAFFER 21-13-0587 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not list Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS(Indude outright spousal distributions and transfers under Sec.9116(a)(1.2).] 1• RANDY L.SHEAFFER,477 MT.HARMON RD,EARLEVILLE,MD 21919 SON ��2 2.! :SANDRA K.SHEAFFER,1 HOLLOW ROCK,LINCOLN UNIV.,PA 19352 DAUGHTER '1�2 __ __ _ _ : ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II NON TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECfION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: _ _ _ _____ _ _ _ _ _ _ _ _ „ _ _ 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. __ _ ___ _ ___ __ __ _ _ _ _ _ _ _ TOTAL OF PART II—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed,use additional sheets of paper of the same size. a i r�sr c�.rr.���v.v rESr���1vr OF GA��E K. SHEAFFER I, GAYLE K. S�IEA►FFER of? �ountry Club Road, Ca.rlislc, Cumberland County, Pennsylvania, 17013,being of sound and disposing mind,memory and understa.nding, do make,publish and declaxe this as and for my��,ast Will and Testament, hereby revoking and making void any and all former�XTills, Codicils, or writings in the nature thereof, by me at any time heretofore made. FIRST: I hereby order and d.irect my Executor, hereinafter named, to pay all my just debts, funeral expenses, testamentary expenses and all Inherita.nce, Estate, 1'ransfer and 5uccession Taxes, as soon as may be conveniently done after my death, out ot my residuary estate. SECOND: I give all the rest, residue and remainder of my esta.te be it rea1, personal or mixed, or whatsoever kind, of wheresoever situate, to my children, S.ANDRA K. SHEAFFER and RANDY L. SHEAFFER, in equal shares. Should either of my children predecease me, I give that child's share to my surviving child. LASTLY: I hereby nominate, constitute and appoint my children, SAND1tA K. SI�E AFFER an.d RAND�C' .L. SHEAFFER, to be Executors nf this,my Last `Ylill and "I"estament, they to serve without Bond in the Commonwealth of I'ennsylvania, or any other jurisdicrion. In the zvent that either of my sa.id children shal] predecease me or be unable to act as Executor of my Esta.te or comp�ete the administration thereof for any reason whatsoever, my other child shall act in his or her place as Executor hereof. IN WITNESS WHEREOF, I, Gayle K. Sheaffer, have hereunto set my hand and seal to this my Last Will and Testament, this�day of���'_� -� , 2012. Gayle . Sheaffer, Testa.trix Signed, sealed, published and declared �j= the above-named Gayle I�. Sheaffer, Testa.trix, as and for her Last Will and Testament in the presence of us, who have hereunto subscribed our names at her request as witnesses thereto, in the presence of sa.id Testatrix and of each other. �� � ADDRESS 10 W. Hi�h Street Carlisle. PA 17013 . ADDRESS 10 W. High Street Carlisle, PA 17013 COMM�rJWEALTH OF PENNSYLVANIA : . COUNTY OF CUMBERLAND • We, Gayle K. Sheaffer, James D. Flower, Jr, and ��JrG L , l�irr��the Testa.trix and witnesses, respectively whose names are signed to the foregoing or attached instrtunent, being first duly sworn, do hereby declare to the undersigned authority that the Testa.trix signed and executed the instrument as her Last Will and Testament and that she signed willingly and that executed as her free and volunta.ry act for the purp�ses therein expressed, and that ea.ch of the witnesses, in the presence and hearing of the Testatr� signed the Will as �vitnesses and t�at to the best of their knowledge the Testa.trix was at the time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. , G e K. Sheaffer James D. Flower,Jr. Witness � • r On this, the /a-� da. of ���• 2012 before me the undersi ed Y > > , gn officer personally appeared James D. Flower,Jr., Esquire, known to me (or satisfactorily proven) to be a member of the bar of the highest court of sa.id state, and a subscribing witness to the foregoing instrument, and certified that he was perspnally present when the testator and witnesses,whose names are subscribed to the foregoing instrument, executed the same, and that they acknowledged that they executed the same for the purposes therein contained. IN�ITNESS WHEREOF, I hereunta.set my hand a.r�d official seal. (SEAL) Nota.ry Public ���atwoNw�A�TM oF r�:�����v�.vwwun, �� PtOTARiAL SE�� TNQMAS E.FLOWER,No:�,�PUbi'�c ���iis{e Baro.,Cumberl��� � �'ounty ��:���',�mmission Expires Oc: .. ..�5,2014