HomeMy WebLinkAbout03-24-14 REV-1500 3505610143
° °''°'
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania ca.nycod= Y� Fm Nwi�
Bureau of Individual Taxes
PO BOX280601 INHERITANCE TAX RETURN 21 13 0316
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Meth
01 30 2013 OZ 01 1924
Decedent's Last Name Suffix Decederds First Name MI
WILLHIDE ROBERT L
(If Applicable)Ender Surviving Spouse's Information Below
Spouse's Last Name Suffer Spouse's First Name MI
Spouses Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
A 1. Original Rehm 2 Srrpplemerxbl Return ® 3. Remandw Rearm(date of death
pinto 12-1384
4_ Limited Estate 41( ��f ® 5. Federal Fite Tax Return Required
6 o.�xdsn[>iedTcsla+= Ii0 7, D�r�M�e��Lwr9Trus a. Total Nuinberof Safe Deposit B°xes
(AF�.h Cap?ofwilQ
9_Uligaliori Proceeds Received ❑ 10_gPO1. 12s1�37�7- dam' 77 Dec(ion to tax corder Sec 9713(A)
(Attach Sdr.O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFlDENifALTAX INFORMATION SHOULD BE DIRECTED TO--
Name Daytime Telephone Number
JERRY A WEIGLE ESQUIRE 717 53g 7388 0
s ;0rn
REGISTE WFi.4t1S USiANL� C>
M :if C1
First line of address D Z S M rn
O
T O O
126 EAST RING STREET `
Second fine of address C -n
N
City or Post Office _ state ZIP Code �TE FILED CM CO
SHIPPENSBURG PA 17257
Conesponderift e-mail address:
Under p rtalfies of perMy.I declare that I have exanured this return,hnfu?na a Panyag schedules and�+^^�^cam and to the best of my knowledge and belial.
d is Hue,coned and mnpleie.Declaration of pepaer other than the person-I represen(ative is based on all bdorma6on ofwhidr peps has airy krKwMgs
SIGNATURE OF PERSON IEjLE FQHj OUNGFiET1RiN nAXE
✓)V (/(/itz J Cindy L Shoap
ADOFtESS � 71
o?D j�/ I/ -54 /dpi Z 6ar9
1.2257 611'0'e'05
{►iV'Ir tf
SIGTW ARER(m�R THAN S DATE
Jerry A.Weigle Esquire
ADORE
126 East IGng Street,Shippensburg, 17257
Side 1
L 1505619143 1505610143 J \
PA Inheritance Tax Return
Signature of Additional Fiduciaries
ESTATE OF FILE NUMBER
Willhide,Robert Leo 21-13-0316
Under penalties of perjury,I declare that 1 have examined this return,including accompanying schedules and statements,and to the best of
my knowledge and belief,it is hue,correct and complate-Declaration of preparer other than the personal representative is based on all
information of which preparer has any kmowledge.
Signature#2
Name Earl Lwllhide
Addressl 331 E.orange Street
AddreSS2
City,State,Zip Shtppenshurg,PA 17257
Date Z v - i y
1505610243
REV-1500 IX
Decedent's Social Security Number
'-r- Willhide, Robert Leo
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1. 55,000.00
2. Stocks and Bonds(Schedule B)............................................................................. 2_
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)--------- 3
4. Mortgages&Notes Receivable(Schedule D)_........................................................ 4-
5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 3,335. 83
6. Jointly Owned Property(Schedule F) ® Separate Billing Requested........... 6.
7. Inter-Yrvos Transfers&Miscellaneous toq Probate Property
(Schedule G) u Separate Baling Requested.-...------ 7-
8. Total Gross Assets(total Lines 11-7).--................-.......................................... 8. 58,335-83
9. Funeral Expenses&Administrative Costs(Schedule H).........._.......................... 9. 17,409.28
10. Debts of Decedent,Mortgage Liabilities,&Liens(Schedule 1).............................. 10. 19,552- 95
11. Total Deductions(total Lines 9&10)..............................................._ 11. 36, 962-23
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 21,373- 60
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made(Schedule J).....---------------------'-------------------- 13.
14. Net Value Subject to Tax(line 12 minus Line 13)............................................... 14. 21,373. 60
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of line 14 taxable
at the spousal tax rate,or
transfers under Sec 9116 15 0. 00
(ag1.2)X.00
16. Amount of line 14 taxable 21,373. 60 16. 961-81
at lineal rate X .045
17. Amount of Line 14 taxable
at sibling rate X.12 0.00 17. 0-00
18. Amount of Line 14 taxable
at collateral rate X.15 0. 00 18. 0-00
19. Tax Due .................................................................................. 19. 961_81
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. El
Side 2
1505610243 1505610243
REV-1500 EX Page 3 File Number 2143-0316
Decedent's Complete Address:
DECEDENTS NAME
W
illhide,Robert Leo
STREETADDRESS
120 N.Fayette Street
CITY STATE ZJP
Shippensburg PA 17257
Tau Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 961.81
2 CredisfPaymens
A. Prior Payments 0.00
B. Discount 0.00
Total Credits(A +B) (2) 0.00
3. Interest (3) 0.00
4, If Line 2 is greater than Line I+Una 3,emerthe difference. This is the OVERPAYMENT. (4)
Check box on Page 2 Line 20 to request a refund
5. If Line 11 +Lure 3 is greaterthan Line 2,enter the ddference. This is the TAX DUE. (5) 961.81
Make Check Payable to: REGISTER OF VVILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN"V IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;............................................................................... ❑ Fxl
b. retain the right to designate who shag use the property transferred or its income;.................---------------- ❑x
a 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
recemrrg ❑equate consideration?.................................................................................................................... x
3_ DM decedent own an in trust for or payable upon death bank account or security at his or her death?....... ❑ Q
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.
For dates of death on or after July 1,1994 and before Jan.1,1995,the tax rate unposed 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)(t].
For dates of death on or after January 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(1.1)001 The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for d"sciosrue of
assets and filing a tax return are still 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 transfers from a deceased duld 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 Mild is 0 percent[72 P.S.§9116(a)(12)]_
•The tax rate unposed on the net value of transfers to or for the use of the decederd's lineal beneficiaries is 4.5 percent,except as noted in
72 P.S.§9116 1.2)[72 P-S_§9116(a)(1)1.
•The tax rate unposed on the net vatue of transfers to or for the use of the decedents sdrtings is 12 percent[72 P-S_§9116(a)(1.3)]. A
sibling is defined rmder Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
Rew1502 FXa(114M
SCHEDULE A
REAL ESTATE
cceueowc�xrxaEeesaxruax
eu�avet�rRx ar=rt[al
Rr�xro�c®ssr
ESTATE OF (FILE NUMBER
Willhide,Robert Leo 21-13-0316
All matproperty awned salety ar a sareoardinwnuronnbereputed rtfairrrerl[et rdlve.Fah madot�n.e isdaS WSi asfiepri�3utdfi RW='dYww�ba
agltayy�batapen awr4ug Inryerandaw�rg se4r,ry 4b *7�0�to huyuseA,bath haYm9 rzasur�deImmxledge offtreL�rat.
Real property whidrisjaSnQyaxn¢d r79tdfrd arsuvivuship mist be dtsdosed onsch .F.
Anach awpy otrtww lanvGSheet nL Popedy hasbeensold
Indudeacopyafdredeedshowing dewdenrshduestrfaccred asis lnconuour.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Real estate located in the Borough of Shippensburg,Cumberland County,PA with address 55,000.00
of 120 N.Fayette Street,Shippensburg,PA 17257 Parcel 03434-2417-074 with w story home
serviced with public water and sewer,also parcel of land Parcel No.#3434.2417-075 Deed
BookZ22,Page744,sold 11-7-13.
TOTAL(Also enter on Line 1,Recapitulation) 55,000.00
(If more space s needed,additional pages of the same sae)
Copyright(c)2009 form software only The Lackner Group,Inc_ Form PA-1500 Schedule A(Rev.11-05)
• Rev-iSaeIXt(a-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
' cox�own�ecrxaFvexuc
r�rrarr�rrxR�nca�
Res®a+ro�r
ESTATE OF FILE NUMBER
Willhide,Robert Leo 21-13-0316
�fmANe fhep[o�of IN'�ae�ard the de[etE�pmceedswaere�w„dpy Bie esa�
Pr�PerfYlovdlyuwnedoalh ere d9M ofsvrivarship nnct be dadosed an she F.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
1 Cindy L Shoap-payment to estate for share of electric bill 45.00
2 County Tax-prorated at real estate settlement 9426
3 M&T Bank Checking Account 1,314.12
4 School Tax-at real estate settlement 740.95
5 2002 Ford Escort-did not run-Proceeds of sale-4130113 300.00
6 Personal property-Cash from sale of personal items 841.50
TOTAL(Also enter on Line 5,Recapitulation) 3.335.83
(If more space is needed,adMonal pages of the same sue)
Copyright(c)2002 form software only The Ladner Group,Inc Form PA-7500 Schedule E(Rev.6-98)
P"4151 EX-n"6}
SCHEDULE H
col i - ft"`^r, if�ti FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Willhide,Robert tea 21-13-0316
Debts of decedent must be reported on Schedule 1.
ITEM DESCRIPTION
N MBE AMOUNT
A. FUNERAL EXPENSES:
See continuation schedule(s)attached 9,650.50
B. ADMINISTRATIVE COSTS:
L Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City state 2uD
Yearfs)Commission raid
2. Att,uneVs Fees Weigle&Associates,P.C. 3,500.00
3_ Family Exemption: (If decedent's address is not the same as daimaM's,attach explanation)
CtaBmant
Street Address
City state MD
Relationshin of Claimant to Decedent
4_ Probate Fees 413M
5. Accountants Fees
6. Tax Return Preparees Fees
T Other Administrative Costs 3,845.28
See continuation schedule(s)attached
TOTAL(Also enter on line 9.Recapitulation) 17,408.28
Copyright(c)2009 form software only The Ladner Group,Inc, Form PA-1[500 Schedule H(Rev.10-06)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Willhide,Robert Leo 29-13-0316
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
i Fogelsanger Bricker Funeral Home 9,650.50
H-A 91650.50
Other Administrative Corte
2 Dean E.Alleman-Auctioneerfor Public Auction 578.20
3 News Chronicle-Advertising 113.00
4 Real Estate settlement Expense including Release 2,869.08
5 Register of Wills Cumberland County-File PA inheritance Tax 15.00
6 Reserve for Release to be filed to complete estate administration with Register of Wills, 20.00
Cumberland County
7 Sailhamer Real Estate-Appraisal of Property iQ0.00
8 Sallhamer Real Estate-Supplemental Appraisal 125.00
9 Weigle&Associates,P.C.-Reimbursement for postage,xerox copies and tong distance 25.00
phone calls
H$7 3,845.28
Copyright(c)2002 form soHaare only The Lackner Gmup,ink. Form PA4500 Schedule H(Rev_6-98)
Rev4612IX+(12-08)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ahetuouxrtthnaFr�uJSttvusic
oca3xroee�rnxnehumu
�o!xro�atr
ESTATE OF (FILE NUMBER
Willltide,Robert Leo 21-13-0316
Report debts mmned by the deceda priarta death Vu amaived unpaid atdu deeadeath,rnduftg muWn u medicale�enses
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
1 rCentury t Pharmacy-Medications and supplies 512.25
2 Link-P hone Bill
128.88
3 CFJMA -Sewer Billing 10000
4 Elmcroft-Nursing Home 6,629.59
5 H&R Block-Income Tax Preparation 150.00
6 M&T Bank Checking Account -Checks clearing after date of death 7292
7 M&T Bank Home Equity Loan-payoff of Home Equity Loan 11,70208
8 Penelec-Final electric bill
22.26
9 Shippensburg Borough-Water Billing 7212
10 West Shore-Ambulance billing 16285
TOTAL(Also enter on Line 10,Recapitulation) 19,552.95
(R more space is needed,additional pages of the carne sue)
Copyright(c)2009 font software only The Lackner Group,Inc Form PA-1500 Schedule I(Rev.12-08)
REV-1613IX+(H-08) '
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
Wilihide,Robert Leo 21-13-0316
NAME AND ADDRESS OF RELATIONSHIPTO SHAREOFESTATE AMOUNTOFESTATE
NUMBER PERSON(S1 RECEIVING PROPERTY DECEDENT Wes) ($S$)
no M stT s
TAXABLEDISTRIBUTIONS [ndude outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)
1 Jay E.Clough Stepchild One-Third 7,124.53
8810 Pineville Road
Shippensburg,PA 17257
2 Cindy LShoap Daughter One-Third 7,124.53
120 N.Fayette Street
Shippensburg,PA 17257
3 Earl L Willhide Son One-Third 7,124.54
331 E Orange Street
Shippensburg,PA 17257
TOW 21,373.60
Enter dollar amounts fordistnbuffons shown above on lanes 15 through 18 on Rev 1500 cover sheet,as apprormate.
NON-TAXABLE DISTRIBUTIONS:
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART It-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-i50d COVER SH
Copyright(c)2009 farm software only The Lackner Group,Inc. Form PA-1500 Scheduled(Rev.11-08)
MM&TBank
499 Mitchell Road,Millsboro,DE 19966 Adjustment Services
Phone 888-5024349
F ax (302)934-2955
Weigle&Associates,P.C. June 12,2013
Attorney at Law
126 East King Street
Shippensburg,PA 17257-1397
Re: Estate of Robert L.Willhide
Social Security,
Date of Death:January 30 2013
Dear Sir or Madam:
Per your inquiry on June 04,2013,please be advised that at the time of death,the above-named decedent had on
deposit with this bank the following
1. TypeofAccmart CheckingAccowit
AccomaNumber - 77963180
Ownership(Names oj) Cindy Lou Shoop
Robed Wdlhide
Opening Date 0310711996
Balance on Date ofDeath $1,314.11
Accruedlyderest $ .0I
Total --------------
.57,31412 -----------
2. TypeofAceouM Sovi]WAccount
AccamtNumber 15004206814889
Ownership(Names oj) Cindy Lou Shoop(POA)
Robert Wdlhide
Opening Date 1012111999
Belonce on Date ofDeath S aoo
Accruedlnterest S .01
Total -$0.01-------------------------------
n5aa�s.a a �HU CvNnm ILu:uRA3
A. Ser?ement Statement U.S.Deparkrent of Housing ard Urban D-,eF xnent
fib -^f Loan ORSB Anorwal No.2502-0�
1. DF A 2 OFr3zA 3. f3Conv.UnV- 6.Fla ift b er 7.tmn Number 8.Mortgage kei ce Case N"w
4.!!A S. Ca .I 1324MADM
C.NOL> .mima m•' - B7xass Seitaw'd Syt,,.m
'f rv�-t'.�aaameeasase.rmnemmnxe�:e sr:,�r-xta are�mrevramerems TiViE
1•G:WLi3 Ck an�b v 4a1e1sbbge U0ct5SSCmgk�zryoESaslNylmm PCUbve¢m
vesmmn:.r:xaamaa - r-��s.e�rue.au.soi,xsmrma snsc.s,�a PrmtrJi1N37.113 a14i:Io"ASF
D.t4AMEOP 30RROW3t Jerry S.Wadsland Genevievewadet
ADD.RM: 7677 White Chumh Ro4 S " onshuro PA 17257
F HAAC,OF SB.Ir"R: The Robert L Wilfhide Estate
ADDRESS:
F.N44'c OF LENt
-
Dc""
ADDR-
G PROPEffi-YADDRE55: 120 N.Fayette Street 122 N.Fayette Street,ShQpensburs PA 17257
Cumberland County,Shippansbarg Borough -
H SEFR-90ff AGeEW' South Central Home Settlement;,Inc,Telephone:717.532.7387 Fax:717.532.6552
PROF SEi S11M*r: 126 East lGra Street SWippensburg,PA 17257
6S-TR36ENT DA-I= 7110612013
A SUMMARY OF BORROWER'S TRANSACTION: K.SUMMARY OF SELLER'S TRANSACTION:
100.GROSS AMOUNT DUE FROM BORROWER 40%GROSS AMOUNT DUE TO SELLER
101. CMIn3d sas Pdce - 55000.00 408. Coatradsabs wte 5500100
102 P-=nal 402. Perordpoperty
103. S-fimzanl charges to bonomu Lma 14 1,109.00 403.
104. 404.
105. 405.
ATWmaws for hams paH by se0s6r adaen,, A? sungYSftvOems vSain advanco
117. tam 11106N3b12f31113 94.26 407. Cmm taws 11106113bi2131113 94.26
1M Sdiwl Tam 111DM13h06T3W14 74005 488. School Ta lQ06113b061=4 74055
is 403.
110. 410.
111. I 411.
112 412
120.GROSS AMOUNT DUE FROM BORROWER 5SS44.21 420.GROSS AMOUNT DUE TO SELLER 55035.21
201 AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500.REDUCTIONS IN AMOUNT DUE TO SELLER
201. 1 501. Fitcess ce sa=-fm#ucfeua
202 Prindual aswt of neahaas 5PL S-Werrv�d drargm bselar Mo 1400 - 66906
2n Bd55q Lrrfs t3tensubie to 5D3. s t eclb
MC 504• Para of FCS MwLww Loan 1170208
MST Bank
205. 505. Partifofseaxd ban
206. a5)&
277. 507.
2M 1 581
20. 5M.
Ad'ustments for items unpaid by seller Achust rents for items un 'd by sellu
213 513.
214. 514.
215. 515.
216. 515.
217. W.
218. 518.
219. 519.
220_TOTAL PAR)BYIFOR BORROWER 5M.00 1 520.TOTAL REDUCTION AMOUNT DUE SELLER 14571.16
300.CASH AT SETTLEMENT FROM OR TO BORROWER 1 600.CASH AT SETIJIME1TTO OR FROM SELLER
301. Cx sa=. Iduaka bamwmr m12M 56.944.211 M4. Gmss ammudan_fo 4 55 1
3D2 rssoTDTItGM6Jb%ftbummsrMe2201 50D000 1 632. Iess reduc0ai amountdoe sefferfts5M 14 1.16
303.CASH FROM BORROWER 5194421 1 603.CASH TO SELLER 4126C05
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rW��bev£f+ebLYQa [rv6ts Wb(a,e Mq ®Yi4tB�vnm6v.ipu EeeLLry��A T�mn1G�faem
VOrfN. rsmlaman caNVbvsnwRs GY�emr��t�tl�C�m®9r.
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U.S.DE?kRiMWrOE N0USMANDURaWDE_-Y3OPMENT :v Nuscb_r 132443WADW- PAGE
SEMEMENTSTATEMEN3 ;4e�zssS� m n sin P �ss�ffit3atss:l9ASP
t. S ENT CHARGES PAID FROM PAID FROtd
700.TOTAL SALEWSROKEA'S COMMISSION based an mir_e5S5D00.0000.000= BORROW-Mrs SaLLeR'S
D dsbi ofmMabsiml_r(_n;7031n fog= FUNDS AT FUDIDS AT
709. S to SETttFMWt SETII.EMENT
702.S b
7a Co� at SEI0-lord
800. S PAYABLE tN CDYdNECMNYMLOAN
801. Lca nFee %
am fma❑tasted % ._
803 Aoma"Faa f
604. CfeQ FbMd
005 _
8D& _
807.
809
8D9.
813.
900.MS REOURED BY LENDER TO BE PAID IN ADVANCE
901. iotrea Rmo b ift
902 M kmvaace Pr l m for b
903. HaMd 61 ' Pmmfsn:for b
944. _
905. u
1000.& SDEPO511' WITH ER OR
IOWL.L zmd kma M. fmm
ttki2 I� nm. laao
1003.Cwypmo3oTm mo.l0 taro
M.CamtrPmapatlTa ma S AM
1005:Sdw Ta M $ fmo
IM mwleA.a3Mri5 Ad
ift TITLE CHARGES
4301.Sett! atrmCirain Fe: b South CentrAHwe Seto ns Mg. 425.
1102 Abstad"T&Search
1101 TIL.EY-VM aeon _
1104.T10a knnronce Bhdsr
1105.OCruruW PMDXEIII to South Central Homeseitlaments.Im 175M
1106.No("Fme
1107. faros
af>oxa�ns f&x
1103 Toe kuu;kxa _
Mi*dmah�lbmsft _ 1
1103
ilia Omd5cmMps
Mi.
1112
W3.
1200.GOVERHMM RECORDING AND TRUSFER CHARGES
12D1. Fa DMd$t M -Ruse$ 1 134.001
12D2. Deed$55MOD :tMmAma$ 659.QII
12DI SWLTaxistp% Dawssm.00 -$ .00
1204. Dom$ $
1205.
1300.ADDtTi lSE17LEMEFI7 CHARGE
1301.
1382 P-bb¢dTazGdFw b South Central Hom>Setrl�LS m 2DA0
1301$N Qmrh Taxlbctmm l to Bomuehof Shimansbire _ _ 614.41
1304. M3SffWLmM(0rnar?4 b 8otooall of Shioannslura 141.4
1305.Rd Water$ aTrash t b BmughofShippamburg 81.d4
JMFinalWefarS= Trd5h91223 b Bomtmbof bur 287.04
1307.
1373
1400.TOTALSEMEMENT CHARGES eotam Boas 103.Sec9mJ ardMZ SdbnM 209.08
earoamssrwaspghuero�F�ainm�ariuosxen
bI# rt�u�rt9etiiomY6 d3aaPl�aa MIIf SeLZ.sntSit®a1lHxuw aartsfecal�.atddmrrband Ed�ev mis m�honaYC.nudrtUfine
ttiuemG;rssxam�mmmnsa-,ivrw�rusesm�nsmt� mneenrea'xa�mamna.ranr baew.n.x.maa aaaansucaa�
rTat®egiE'3atnescnuwswunn r[wl vaw;rGSLL'bv ea�NCtlav r evsfa«evosmme c r�m+i4tt�cmemm
UnSNOOOe'�CTrT 6tlm�aAOS�Itlxt ���et£sntE CS
LAST WALL AND TESTAmENT
I, ROBERT LVIf I1UM, of 120 North Fayette Street; Aippensbnrg, Cumberland
County, Pennsylvania 17357 do hereby make, publish and declare this to be any last will and
testament, hereby revoking all wills Heretofore made by me_
I. I direct my personal representative to pay all of my debts, funeral and
administrative expenses as soon as convenient after my decease.
I authorize and empower my personal representative 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 representative 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 representative_
3_ I give, devise and bequeath all of my estate of whatever nature and wherever
situate to Cindy L. Shoap, Earl L. Willhide and Say E. Clough, share and share alike, the child or
children ofany deceased beneficiary taking the share their parent would have taken if living.
d. I nominate and an Cindy L_ Shoap and Earl L_ Wdlhide to be the co-personal
representatives of my estate,to serve without bond.
5. I suggest that my personal representative retain the services ofHarold S_Irvin,III,
Carlisle,Pennsylvania in the settlement of my estate.
b
LN WM�ESS WUKIREOF, I have hereunto set my hand and seal this j7 day of
April I997_
�(SEAL)
ROBERT WILLIIIDE
Signed, scaled, published and declared by the above-named person as and for a last will
and testament, in our presence, who at said persons request, in said person's presence and in the
presence of each other have hereunto set our names as subscribing witnesses.
ACKNOWLEDGMENT AND AFFIDAVIT
WE, ROBERT WILLUME, GAY L. IRWIN and JOY S. ZERANCE, the testator
and witnesses respectively, whose names are signed to the foregoing instrument, being first duly
sworn, do hereby declare to the undersigned authority that the testator signed and executed the
instrument as his last will and that he had signed viffingly, and that he executed it as his free and
voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and
hearing of the testator, signed the vrill as a;witness and that to the best of their knowledge the
testator was, at that time, eighteen years of age or older, of sound mind and under no constraint
or undue influence.
rT 1,96&1
ROBERT WILLIME
GAY L.IRWIN
/i/ J S:z
JOY S.Z1r'ift.AINCE
COMMONWEALTH EALZR OF PENNSYLVANIA, :
:ss:
COUNTY OF CUMBERLAND
Subscribed, sworn to and acknowledged before me by ROBERT 13'-ILT.TITt)E, the
testator herein, and subscribed and sworn to before me by GAY L. IRWIN and JOY S_
ZERANCE,witnesses,this__L7,`day of April, 1997-
Notary Public _
Cumherland County Office of Aging
SERVICE ORDER FORM.
C'm5 of Setvioe Parsonal Cate Noma SuMorl—_AAen Cates Legal Day Caa_Other
Caged To-
i
Chant :_����$ t�-�,��= _Yom: S 3��t�£;�* _ssr•.���-t�- 4l�`�
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Physician: �� Lf U� ✓��,,+�vx". vr1� ell-u✓2t7�?.37rii'-�tsrene: ;
Cottfact � _ �� �L� ' _Phone: Rat " Frhio:
Ptry'NcaN
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IN HOME SERVICES TO BE PROVIDED
A. PERSONAL CARE B. HOME SUPPORT
t,AUWRY-__—
t3E7? ^-.-
TUB SHO'NER _ GROCERY SHOPPING
Smw POO ERRANDS(specify}—_
ORAL tsl CEEDIc
DRE=NG HOIJSEKEEPING(ATT_Care Only)
OTTER OTHER -
C. ELIMINATION D_ NUTRITION:
TOILET MEAL PREPARA11ON
€3F WDE Fmf NNG
PA MRiNAt FLUIDS_ .
CATHETEFUC3�TOt,AY - DNET _
O f tiEI3 OTHER
E. ACTIVITIES F. SPECIAL. INSTRUCTIONS
raANSFt R _ _ G. _{ SZL= 5 _c '•�3f
€�EPtasNTtot+Nrs�tRnN --
lNSTRUCTNON
AESPNTE
°TRER - MAXIMUM MONTHLY HRS
SUNDAY I MONDAY TUESDAY 9 YID -MURSDAY - FRIDAY SATURDAY
OTHER SERVICES' Legalsenric-e-"161_. _hours_ Day Cara Days___,_
c lease be add 4 A that no SeNice Changes Can be r ado without auihoe zation of the ca ort r Iisled above-
All questions should be addr-essed to the above caseworker.
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