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Home My WebLink About02-0534Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Jarvis Kenneth Shaffer No.G ~~Q2 - 5 3~ also known as Jarvis K. Shaffer Deceased Social Security No. 193-12-7720 (COMPLETE "A" OR "~evo r, .,~,,,,. =gyp, B" BELOW:) A. Probate and Grant of Letters and aver that Petitioner is the executrix named in the Last Will of the Decedent, dated August 26. 1987 and codicil(s) dated none .,„a,e~er«„Y ~~,~~m,,.z.,, e.o-..w~~~~,oo~, eee,~ eY,.,~~,o,, aY~. Excapt as follows, Decedent did not marry, was not divorced, and did not have a child horn or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: NONE Hamden Township Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence at 514 Colonv Road Camo Hill PA 17011 um:eee,. ~~~noe, :,oa Rx,iomwl~wl Decedent, then 82 years of age, died Mav 1, 2002, at Holv Spirit Hospital Camo Hill PA 17011 ao=aarm Decedent at death owned property with estimated values as follows: Ilf domiciled in PA) All personal property ............................ $ 168.000.00 Ilf not domiciled in PAI Personal property in Pennsylvania ........... $ (lf no[ domiciled in PAI Personal property in County .............. $ Value of real estate in Pennsylvania ..................................... $ Total ............................. ... ......... .. ... ................ S_ 168.000.00 Real Estate situated as follows: ~ ~ ~ ~ ' Wherefore, Peti [ionerls) respectfully requ estls) the probate of the last Will and Codicillsl presented with this Petition and the grant of letters in the appropriate form to the undersigned: Si nature Typed or printed name and residence i 'Z Shirley B. Shaffer, 514 Colony Road, Camp Hill, PA 17011 foini Nw-1 Pnge 1 0l L IDnupYiiii i_ounwl -Per. ~, 9'[ f~ B. Grant of Letters of Administration m e.~.~.c,.: po~a~me li,e; aora~„e ame~u.; e~rao,e mmaa,mel Petitionerisl after a proper search has/have ascertained that Deredenr left nn will ~..d ,.,~< <,,..,:.,,.a ~.. ..._ ._~,_...:__ __ _ Oath of Personal Representative Commonwealth of Pennsylvania County of Dauphin The Petitioner above-named swears and affirms that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner and that, as personal representative of the Decedent, Petitioner will well and truly administer the estate according to law. Sworn to and affirmed and subscribed "~ ~' Shirley .Shaffer before me thi~{~s 3'° day of June, 2002 No. 2 I ' O 2 - ~ 3 ~ Estate of Jarvis Kenneth Shaffer a/k/a Jarvis K. Shaffer, Deceased Social Security No: 193-12-7720 Date of Death: Ma 1 2002 AND NOW, JUNE 4, , 20 02 , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT tS DECREED that Letters Testamentary are hereby granted to Shirley B Shaffer in the above estate and that the instrument dated August 26, 1987 described in the Petition be admitted to proba*.e and filed of record as the last Will of Decedent. FEES Letters ........................... S 235.00 Short Certificate(sl...•(21.. Renunciation .................. Affidavit ( 1...•.~ ~•~~~• ~~~ Extra Pages ( ).....~~~ •~~ Codicil .......................... Rec. Mgmt. Fee JCP Fee ........................ Inventory ....................... Other ............................ S 6.00 S S S 12.00 S S S 5.00 S S TOTAL ................ g 258,00 l Llht ~~ / ~ . o o~ D Register of Wills Attorney: Earl Richard Etzweiler I.D. No: 06398 Address: 105 North Front Street Harrisburg PA 17101' Telephone: 717 234-5600 c~iir raw-~ rds, z o~ z io.~~~nm ro~~~r~ -u~~. s,xr , ~ + ~s ro cc chat r c uvbrmarion here given is con'ecdv copied Gom an original cernhcate of death duly filed with me as L o il R_gul .. [ Ile of I>;nlal cerntleare will be forwarded ro the Slam Vital Records Office for permanent 6iling. \1lARNING: It is illegal to duplicate this copy by photostat or photograph. Fey fnF this cerrincaee, 52.00 __ P ._8204200 Iti L/. I -YPE/pNIN) IN PENMAHENL BLALM INN Lucil Registrar t~rlre COMMON W EALTH OF PENNSYLVANIA • OEPAgTMENT OF HEALTH • VITAL flECOflOS CERTIFICATE OF DEATH HI~L,URe.~,) ..] uw .\ME OF DECEVENTIfva MgyW Sayl ~~---'--' " __-_---- $EY 50CML SECUPOV NUYBEq p.<)F Of VEniN,MCnN. Vay, yr ~e .3viS K. 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'CER1MVNq pNY61GAXrFTysa'unen YMtausatl Ma raryn erw nn p.vsrannas LaN•wY el mrYrv.Ippa bamwturM Cwre N•.au .eam a~wc nn tall .NN.,pmwwr..Y• ~ __.... _..._ sIGXOpiITL OFCEP ' ~ ~c ~ Jae ,~t _.. _..... .... ]JN. ~rpoxouNClxo ANpcSRTMnxp PNraIGAN IF*Yar~and,m;„„.,,rn~p,,.,,llraro~nd. mm.e..fdmYYm.IwE• .q`j°wd M,In e..mot.w.wYm.nN e .R uceNSENpNEER paE SmrEOlwwD.r. nail ~ 3 .... . ., aA.ne pLt...naaN. r.pa lr ..,gma,n.r...r.rw __....___ ^ p/ U .. 3E ]r.. 5 -.2-0 1 'MEpIC/rLEYAMI Eq/CMONEP oq m. q..nm I Re I Tp nNn m Nr P 1 a m a WME AHp ADCl1ES9Cf.PF~15ON L~PO~QFIPLE)ED U999FFF Of pES{X m r~ Igtm3)I LYp•pPrNl KA/<,C" ~/]C],`. f'_ V r J ~ / I , .tt.r Iln. e.u P eay.p ..Iq.ga ^ •r•nrea I v P_ / N_L( / 17/ 91 U Ce' Q ` EGS P's5 NA)VPE AHV NVMBEP /// ~-~ - ~ i _ ]]' N/C.S LI ,2 /f ~7V pRE f LEp(MCntlI 0aY Vaarl ~~~~ ~ el~ / LAST WILL AND TESTAMENT OF JARVIS KENNETH SHAFFER I, JARVIS KENNETH SHAFFEK, a legal ~sideo ? o53u~berland County, Commonwealth of Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this instrument to be my LAST WILL AND TESTAMENT. I hereby revoke any and all wills and codicils by me heretofore made. I IDENTIFICATIONS AND DEFINITIONS A. I am married to SHIRLEY B. SHAFFER, hereinafter referred to as "my Spouse." We have two (2) children, BLAKE SHAFFER and TERI ESSEY. References in this Will to "my children" include these children and any other lawful children born to or adopted by me. Except as otherwise provided in this my LAST WILL AND TESTAMENT, I have intentionally omitted to provide herein for any relatives or for any other person, whether claiming to be an heir of mine or not. B. The following definitions obtain in any use of the terms in this Will: 1. "Descendants" means the immediate and remote lawful, lineal descendants of the person referred to, and it means those descendants in being at the time they must be ascertained in order to give effect to the reference to them, whether they are born before or after my death or of any other person. The persons who take under this Will as Descendants shall take by right of representation, in accordance with the rule of per stirpes distribution and not in accordance with the rule of per capita distribution. Persons legally adopted when under the age of fourteen years shall not be differentiated from blood descendants for any purpose. 2. "Survive me" is to be construed to mean that the person referred to must survive me by thirty days. If the person referred to dies within thirty days of my death, the reference to him shall be construed as if he had failed to survive me. 3. As used in this Will, the words "Executor," "he," "him," "his," and the like shall be taken as generic and applicable to a natural person of either sex or a corporate person of other legal entity. Page 1 of 4 Pages C. I have served in the Armed Forces of the Dnited States. Therefore, I direct my Executor to consult the legal assistance office at the nearest military installation to ascertain if there are any benefits to which my dependents are entitled by virtue of my military affiliation at the time of my death. Regardless of my military status at the time of my death, I direct my Executor to consult with the nearest Veterans Administration and Social Security Administration office to ascertain if there are any benefits to which my dependents may be entitled. II PAYMENT OF DEBTS AND TAXES I direct my Executor to pay the following as soon after my death as may be practicable: 1. All of my just debts and the expenses of my last illness, funeral and of the administration of my estate; but my Executor need not accelerate and pay those unmatured obligations which, in his opinion, it might be proper and more advantageous to retain or renew and pay as they become due and payable. 2. All inheritance, transfer, estate and similar taxes (including interest and penalties) assessed or payable by reason of my death, on any property or interest in my estate for the purpose of computing taxes. My executor shall not require any benefic- iary under this will to reimburse my estate for taxes paid on property passing under the terms of this Will. III RESIDDARY ESTATE A. I define "my Residuary Estate" as all of my property after the payment of debts and taxes under Article II, including real and personal property, whenever acquired by me, property as to which effective disposition is not otherwise made in this Will, and property as to which I have an option to purchase or a reversionary interest. B. I give my Residuary Estate to my Spouse if she survives me. Page 2 of 4 Pages C. If my Spouse does not survive me, I direct my Executor to divide my Residuary Estate into equal shares and to distribute those shares as follows: I. one share to each of my Children who survive me; 2. if any of my Children fail to survive me, then his or her share shall be distributed among his or her descendants who survive me; 3. if any of my Children fail to survive me and leave no descendants who survive me, then his or her share shall be divided equally among such of my Children who survive me, or their descendants who survive me, as set forth in subparagraphs 1 and 2 above. IV APPOINTMENT AND POWERS OF EXECUTOR I nominate and appoint my Spouse, SHIRLEY B. SHAFFER, as Executor of this my LAST WILL AND TESTAMENT. If my Spouse, SHIRLEY B. SHAFFER, is unable or unwilling to serve in this capacity, I appoint my son BLAKE SHAFFER of Huntington Beach, California to serve instead. I request that my executor be permitted to serve without bond or surety thereon. I authorize my Executor to do any and all things which in his opinion are necessary to complete the administration and settlement of my estate, including full right, power and authority, without the order of any court and upon such terms and under such conditions as my Executor shall deem best for the proper settlement of my estate; to bargain, sell at public or private sale, convey, transfer, deed, mortgage, lease, exchange, pledge, manage and deal with any and all property belonging to my estate; to compromise, settle, adjust, release and discharge any and all obligations or claims in favor of or against my estate; and to borrow money for the payment of inheritance and estate taxes or for any other purpose. Without in any way limiting the scope of the powers enumerated herein of my executor, I hereby specifically give to him full power to retain any and all securities or property owned by me at the time of my decease whenever, in his absolute and uncontrolled discretion, such a course shall seem to him to be best, without liability for depreciation or loss, and free from investment restrictions incident to executorship, whether imposed by common law or statute. In the execution of his duties and powers as Executor he shall have the power to comply with all legal requirements as to the execution and delivery of deeds and all other writings, documents or formalities without the order of any court; and he shall furnish a statement of receipts and disbursements at least annually to each person then entitled to receive income or property from my estate. Page 3 of 4 Pages Acknowledgment COlVIlV10NWEALTH OF PENNSYLVANIA) SS: COUNTY OF CUMBERLAND ) I, JARVIS KENNETH SHAFFER, Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowled ed before me, by J VIS KENNETH SHAFFER, the Testator, this ~ da of _ Igg7 JARVIS KENNETH SHAFFER, Testator (SEAL) ~j'~~ Notary Public ~C/ A f f l d8 V l t ROSA A. RDDRIGUEI, NDTARY PtIP.FIC CARLISFE BQRCUGH, CUMflFRI%8i d' COUNTY CONIlVIONWEALTH OF PENNSYLVANIA) SS: Member~P~osylQ~aXASSOCiiionotNotanas COUNTY OF CUMBERLAND We, L!~~,e~,u£ ~ ~C~-O~_~ _ and -- -•/3,yicc._LY,~E//~---- ' the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testator sign and execute the instrument as his Last Will; that JARVIS KENNETH SHAFFER, signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the the Testator signed the will as witnesses; and that to the best of our knowledge the Testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. MSworn or affirmed to and subscribed to before me by !! //~~/.f/£_- .~._J'14i~-SCriT and ____ ~~,~~zrcc. n/_~i~' , witnesses, this ~~tiyj day of ~un Lg$7, - --------- _, WIT W I NHS ----------- (SEAL) NO ARY PUBLIC RDSA A. RDDRIGUEI, NOTARY PlIB11C CARFISFE BDRDUGN, CUMBi:~L9KP CGUNTY MY CDMNt ISSIDN EXPIRES Ori.:,? 78%9 Member, Pennsylvania Association of Wotarias IN WITNESS WHEREOF, I have at Carlisle Barracks, Pennsylvania, this ~~pday of -~~ _ 1987, set my hand and seal to this my LAST WILL AND TEST ME NT consisting of four (4) typewritten pages. Signed, sealed, published and declared by the Testator, JARVIS KENNETH SHAFFER, as and for his LAST WILL AND TESTAMENT, in the presence of us, who at his request, in his presence and in the presence of each other, have hereunto subscribed our names as witnesses. NAME ADDRESS ------ ~~/~~yC/u_'y2L~~ -_---__ 1ST' lr""'.-c!>S%1(S!Zr-t u.~cX,t~±'w~ /CL. Page 4 of 4 Pages ETZWEILER AND ASSOCIATES ATTORNEYS-AT-LAW 105 NORTH FRONT STREET HARRISBURG, PA 17101 Earl Richard Gtzweiler (717) 234-5600 Christian S. llaghir _____ HALIFAX LINE (717)896-3737 Fax Line: (717) 234-5610 August 14, 2002 Register of Wills Cumberland County Courthouse Hanover and High Streets Carlisle, PA 17013 RE: ESTATE OF JARVIS K. SHAFFER Dear Sir or Madam: Please find enclosed for filing the following: 1. Two copies of the Inheritance Tax Return; and 2. A check in the amount of $15.00 to cover your filing fee. 2 West Main Street Elizabethville, PA 17023 (717)362-8395 225 Market Street Millersburg, PA 17061 ~7t 7) 6vz-zs 19 I have also enclosed a copy of the face sheet of the Return to be time-stamped and returned to our office in the envelope provided. Thank you for your assistance in this matter. Sincerely, ~, ~. -~- ,/ ~L_ ., Earl Richard Etzweiler ERE:haf Enclosure REV- 1500 EX + (6-00) CAPS HpRL EplO CRAC KOTK ES C P o 0 R t-l R 0 E E S t-l T C o M P T U A T X A T I o t-l REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT /7 FILE t-lUMSER 4..1 o E C E o E t-l T COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST. FIRST, AND MIDDLE INITIAL) Shaffer Jarvis K DATE OF DEATH (MM-DD-YEAR) COUNTY CODE SOCIAL SECURITY NUMBER ~ OFFICIAL USE ONLY t tf'- :<. 531.{ 01. YEAR NUMBER DAT~ OF BIRTH (MM-DD-YEAR) 193-12-7720 THIS RErURN MUST BE FILED IN OUPlJCA,TE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 05/01/2002 IF APPLICABLE SURVIVING SPO SE'S Shaffer, Shir1e X 1. Original Return 4. Limited Estate X 6. Decedent Died Testate B. 2. 4.. 7. Supplemental Return Future Interest Compromise (date of death after 12-12~82) Decedent Maintained a living Trust 3. date of death . Remainder Return prior to 12-13-82) 5. Federal Estate Tax Return Requited 8. Total Number of Safe Deposit Boxes (Attach copy of Trust) 010. Spousal Poverty Credit 0 11. ElectJon to tax under Sec. 9113(A} {date of death between 12.-31-91 aond 1-1-95) (Attach Sch 0) ,i::raIS:SECT[Ot-l;MUSTBE;COMPtE'tEO:;A~'CORRI!DOlloeJljl;e"~~r.(Il,TAX:\tlFQ8MA'l'tQ~~I:lO 'Q'B~QIFl' _jj;r~ NAME COMPLETE MAILING ADDRESS (Attach copy of WlJI) o 9. L1tigatJon Proceeds Received Earl Richard Etzwei1er FIRM NAME (If Applicable) Etzweiler and Associates TELEPHONE NUMBER 105 North Front Street Harrisburg, PA 17101 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(aX1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. FYOU ARE REQUESTING A REFUND OF At-l OVlORPAYMElIlT URE TO At-lSWER All QUESTIOt-lS ON REVERSE SIDE At-lO TO RECHECK'MATH' <,<~~ ' R E C A P I T U L A T I o t-l 4- 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (1) (2) (3) None None None (4) (5) None None (6) None 168,333.92 4,143.00 None SEE INSTRUCTIOt-lS Ot-l REVERSE SIDE FOR APPLICABLE RATES 164,190.92 X ,0 0 (15) X .0 45 (16) X .12 (17) X .15 (18) (19) Copyright (c) 2000 form software only The Lackner Group. Inc. ('-;:'OFFICIAL llSE ONLY (8) 168,333.92 (11) 4,143.00 (12) 164,190.92 (13) (14) 164,190.92 0.00 0.00 0.00 0.00 0.00 ":,;i~ '~X' kiHtX~"^ Form REV-1500 EX (Re..... 6-00) Decedent's Complete Address: STREET ADDRESS 514 Colony Road CITY I STATE I ZIP Camo Hill PA l7011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 0.00 Total Credits ( A + 8 + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty i::!W:i!i!IJ ;.n.,."" Total Interest/Penalty ( D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3. enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58) ",ake Cheek Payable to: REGISTER OF WILL~,. A~ENT "'ii;';':;,:'::::::::::::::::::":::;'r"'::";;;""'i'i",""";:,}";"""""""""""",_",;"",,,,,"';";"'-""':\"1;"""'1;',',';]'1':",];;','1","""",;'::~:~~;~;~~~;~!,~;i,;!~;ii:I~!i!:::::::::::::':::::::r:::ii]j :ji;~:~:;i:~:~~\::~\jV:;~,.!:~!~.,!i!l!!\!..~~~m\l\\,,\\i:l:l\l\:\\:\:\\\\\l\l\:\\,.\;\:mmll\@i!jj!!:~:;:!:i!~\\j . PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X., iN THE APPROPFUATE BLOCKS 1. 0.00 0.00 0.00 0.00 0.00 Did decedent make a transfer and: a. retain the use or income of the property transferred; b. retain the right to designate who shall use the property transferred or its income; . c. retain a reversionary interest; or . d. receive the promise for life of either payments, benefits or care? 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . 3. Did decedent own an "jn trust for" or payable upon death bank account or security at his or her death? 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Yes No ~~ o o o [R] [R] [R] Under penaltles of perjury, 1 declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative Is based on all informatIon of whlch preparer has any knowledge. Shirley B. Shaffer _ _ _S.l~_ 5~'?~-"_,,Y _ py_~,,~_ __ _ __ _ _ _ _ _ __ _ ___ _ __ _ ___ __ _ _ ___ earn Hill, PA 17011 Etzweiler and Associates 105 North Front Street - -Har;:isb~-':-; --pj.,- - Y7icfi -- - --- - -- - --- - -- --- -- --- DATE 9//3/02- DATE For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 PS 9116 (aJ( 11) (ill 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% [72 P,S. 9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the 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 child twenty-one years of age or younger at death to or far the use of a natural parent. an adoptive parent. or a stepparent of the child is QQJQ [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'sllneat beneficiaries is 4.5%, except as noted in 72 P.S. 9116( 1.2) [72 P.S 9116(aX1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(a)( 1.3)J. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Copyright (c) 2000 form software oniy The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) LAST WI LL AND TESTAME NT OF JARVIS KENNETH SHAFFER I, JARVIS KENNETH SHAFFER, a legal resident of Cumberland County, Commonwealth of Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this instrument to be my LAST WILL AND TESTAMENT. I hereby revoke any and all wills and codicils by me heretofore made. I IDENTIFICATIONS AND DEFINITIONS A. I am married to SHIRLEY B. SHAFFER, hereinafter referred to as "my Spouse." We have two (2) children, BLAKE SHAFFER and TERI ESSEY. References in this Will to "my children" include these children and any other lawful children born to or adopted by me. Except as otherwise provided in this my LAST WILL AND TESTAMENT, I have intentionally omitted to provide herein for any relatives or for any other person, whether claiming to be an heir of mine or not. B. The following definitions obtain in any use of the terms in this Will: 1. "Descendants" means the immediate and remote lawful, lineal descendants of the person referred to, and it means those descendants in being at the time they must be ascertained in order to give effect to the reference to them, whether they are born before or after my death or of any other person. The persons who take under this Will as Descendants shall take by right of representation, in accordance with the rule of per stirpes distribution and not in accordance with the rule of per capita distribution. Persons legally adopted when under the age of fourteen years shall not be differentiated from blood descendants for any purpose. 2. "Survive me" is to be construed to mean that the person referred to must survive me by thirty days. If the person referred to dies within thirty days of my death, the reference to him shall be construed as if he had failed to survive me. 3. As used in this Will, the words "Executor," "he," "him," "his," and the like shall be taken as generic and applicable to a natural person of either sex or a corporate person of other legal entity. Page 1 of 4 Pages C. I have served in the Armed Forces of the United States. Therefore, I direct my Executor to consult the legal assistance office at the nearest military installation to ascertain if there are any benefits to which my dependents are entitled by virtue of my military affiliation at the time of my death. Regardless of my military status at the time of my death, I direct my Executor to consult with the nearest Veterans Administration and Social Security Administration office to ascertain if there are any benefits to which my dependents may be entitled. I I PAYMENT OF DEBTS AND TAXES I direct my Executor to pay the following as soon after my death as may be practicable: 1. All of my just debts and the expenses of my last illness, funeral and of the administration of my estate; but my Executor need not accelerate and pay those unmatured obligations which, in his opinion, it might be proper and more advantageous to retain or renew and pay as they become due and payable. 2. All inheritance, transfer, estate and similar taxes (including interest and penalties) assessed or payable by reason of my death, on any property or interest in my estate for the purpose of computing taxes. My executor shall not require any benefic- iary under this will to reimburse my estate for taxes paid on property passing under the terms of this Will. I I I RESIDUARY ESTATE A. I define "my Residuary Estate" as all of my property after the payment of debts and taxes under Article II, including real and personal property, whenever acquired by me, property as to which effective disposition is not otherwise made in this Will, and property as to which I have an option to purchase or a reversionary interest. B. I give my Residuary Estate to my Spouse if she survives me. Page 2 of 4 Pages C. If my Spouse does not survive me, I direct my Executor to divide my Residuary Estate into equal shares and to distribute those shares as follows: 1. one share to each of my Children who survive me; 2. if any of my Children fail to survive me, then his or her share shall be distributed among his or her descendants who survive me; 3. if any of my Children fail to survive me and leave no descendants who survive me, then his or her share shall be divided equally among such of my Children who survive me, or their descendants who survive me, as set forth in subparagraphs 1 and 2 above. IV APPOINTMENT AND POWERS OF EXECUTOR I nominate and appoint my Spouse, SHIRLEY B. SHAFFER, as Executor of this my LAST WILL AND TESTAMENT. If my Spouse, SHIRLEY B. SHAFFER, is unable or unwilling to serve in this capacity, I appoint my son BLAKE SHAFFER of Huntington Beach, California to serve instead. I request that my executor be permitted to serve without bond or surety thereon. I authorize my Executor to do any and all things which in his opinion are necessary to complete the administration and settlement of my estate, including full right, power and authority, without the order of any court and upon such terms and under such conditions as my Executor shall deem best for the proper settlement of my estate; to bargain, sell at public or private sale, convey, transfer, deed, mortgage, lease, exchange, pledge, manage and deal with any and all property belonging to my estate; to compromise, settle, adjust, release and discharge any and all obligations or claims in favor of or against my estate; and to borrow money for the payment of inheritance and estate taxes or for any other purpose. Without in any way limiting the scope of the powers enumerated herein of my executor, I hereby specifically give to him full power to retain any and all securities or property owned by me at the time of my decease whenever, in his absolute and uncontrolled discretion, such a course shall seem to him to be best, without liability for depreciation or loss, and free from investment restrictions incident to executorship, whether imposed by common law or statute. In the execution of his duties and powers as Executor he shall have the power to comply with all legal requirements as to the execution and delivery of deeds and all other writings, documents or formalities without the order of any court; and he shall furnish a statement of receipts and disbursements at least annually to each person then entitled to receive income or property from my estate. Page 3 of 4 Pages Acknowledgment COMMONWEALTH OF PENNSYLVANIA) SS: CDUNTY OF CUMBERLAND ) I, JARVIS KENNETH SHAFFER, Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Testator (SEAL) Affidavit ROSA A. ROORIGUEZ, NOTARY PJ}BlIC CARLISLE BOROUGH, CUM8ERL~NC COUNTY MY COMMISSION EXPIRES ocr. la, 1989 Member, Pennsylvania Associa1ion of Notaries COMMONWEALTH OF PENNSYLVANIA) SS: CDUNTY OF CUMBERLAND ) We, ilJt)y..€!--.!!!Lt:.~w.zr~__ and ...3J.vCG Ll!..JfE/~_____, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testator sign and execute the instrument as his Last Will; that JARVIS KENNETH SHAFFER, signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the the Testator signed the will as witnesses; and that to the best of our knowledge the Testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. /l)sworn or affi~dto and subscribed to before m~ by wni!tef~thff"-afjfl[f{f'tIL~~=-:-Igff.~ .L'L--t~{'fI!_______, ~~-L42 (SEAL) ~-I-N S-- ------------------- C 00 ARY PUBLIC ROSA A RODRIGUE CARLISLE SOROUG,~ ;' NO!~R.Y PUSlIC MY COMMISSION iX;rR~~';;:'ND COUNTY Member. Permsy/v,nia A . l':!. ~'8, 1989 noel.t,on of Notaries IN WITNESS WHEREOF, I have at Carlisle Barracks, Pennsyl vania, th i s 2{,., day of seal to this my LAST WILL AND ~~_ 1987, set my hand and TEST~ENT consisting of four (4) typewritten pages. 4 JARVIS KENNETH Testator Signed, sealed, publ ished a~d declared by the Testator, JARVIS KENNETH SHAFFER, as and for his LASW WILL AND TESTAMENT, in the presence of us, who at his request, in his presence and in the presence of each other, have hereunto subscribed our names as witnesses. NAME ADDRESS 7~_~~ (Ja~ a~+-L <;'<lJ t<f, S=~S7. c-/irk /',4 l'7a/3 ----------;>'-'----- ~-= Page 4 of 4 Pages REV-1510EX +(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Jarvis K Shaffer SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER SSjl 193-12-7720 05/01/2002 This schedule must be completed and filed if the answer to any of questions 1 through 4 or. page 2 is yes. DESCRIPTION OF PROPERTY %OF ITEM INCLUDE THE NAME OF THE TRANSFt).REE THEIR DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE RELATIONSHI? 10 DECEDENl AND lHE DA E OF TRANSFER. NUMBER ATTACH ACOPYOF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) 1 MetLife Annuity Account No. 168,333.92 100.00% 168,333.92 CE228273 . Jarvis K. Shaffer Owner, wife, Shirley B. Shaffer, Annuitant. TOTAL (Also enter on line 7, Recapitulation) $ 168,333.92 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1510 EX (Rev. 1-97) MetLife' @ MetLife AAA A Fixed Annuity For inquiries contact: MetLHe P.O.Box 22030 Tulsa, OK 74121-2030 Tel: 1-800-638-7732 ANNUITANT: DATE OF BIRTH: AGE: STATE OF RESIDENCE: PRODUCT TYPE MARKET: ORIGINAL PURCHASE EFFECTIVE DATE: Statement Dat.e . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . 01/10/01-01/09/02 Statement. Period 01/10/02 ......................................... CE228273 Account # . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NQl Market Tax 10 # ......................................... ON fILE JARVIS K SHAFFER FBO SHIRLEY B SHAFFER 514 COLONY RD CAMP HILL PA 17011 Issue Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 01/10/1985 Employer Group # N.A. Annuitant ......................................... SHIRLEY B SHAffER MAX INCOME PROGRAM QUOTATION - Non-Qualified SUMMARY OF OPTIONS INCOME FOR YOU INCOME FOR A GUARANTEED PERIOD SUPPLEMENTARY CONTRACT SHIRLEY B SHAFFER CE228273 l2/13/1926 75 SEX: Pennsylvania 4 Non. Qual DATE: 01/10/1985 05/01/2002 ANNUITIZATION AMOUNT: COST BASIS: INCOME PAYMENT MODE: ANNUITIZATION DATE: RATE BASIS: Female $168,333.92 $40,000.00 Monthly 05/30/2002 SP020501 (DCS) REV~i5il EX +(1-97) ESTATE OF Jarvis K Shaffer COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER SS{1193-12-7720 05/01/2002 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES, B. ADMINISTRATIVE COSTS, 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip - Year(s) Commission Paid: 2. Attorney's Fees Etzweiler and Associates 350.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3,500.00 Claimant Shirley B. Shaffer Street Address 514 Colony Road Cjty Camp Hill State PA Zip 17011 - Relationship of Claimant to Decedent Spouse 4. Probate Fees Register of Wills 258.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Etzweiler and Assoc iates - postage, photocopies and long distance 20.00 telephone calls. 2 Register of Wills - Dauphin County (oath of personal 15.00 representative) TOTAL (Also enter on line 9, Recapitulation) $ 4,143.00 (If more space is needed. insert additional sheets of the same size) Copyrlghl (c) 1996 form software only CPSystems.lnc Form REV-1511 EX {Rev. 1-97) REV -1513 EX ,. (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Jarvis K Shaffer SSil 193-12-7720 05/01/2002 FILE NUMBER NUMBER I. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under See, 9116(a)(1.2)] RELATIONSHIP TO DECEDENT 00 Not List Trustee(s) AMOUNT OR SHARE OF ESTATE ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS, A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) Copyright (c) 2000 form software only The Lackner Group, Inc. 0.00 Form REV-1513 EX (Rev. 9-00) ~_ , i ~s ': _ ~__ i~N -_... ^8 ~- -- ,. ~_., ~.~ f~' ~- ~; ~ / \ ; ~ `~ ~ ~ V~ J U ~~ W Q $~ LL 0 N fA 3~r. N~ -o Q ~ m T D y in Z T -- a Q C O ~ O LL ~ W¢«y W Z~ O T W N N ,~ m u ~.+ ~ v o w U +~ M ~ ti ~ ~ O ~ ~ oo '. 3 o x w U ~ ~ o b G s+ m m v u N v m N W ',~ •rl •ri p O ~-1 oD 6 G H FG U x U ~~'YS ~` y COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE \ INHERITANCE TAX DIVISION V DERT. 2ao6o1~ NOTICE OF INHERITANCE TAX HARR ISDDRGf PA v12e-oeDl pppRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT DF TAX %EY-150 E% %FV 101-5n DATE 09-30-2002 ESTATE OF SHAFFER JARVIS K DATE OF DEATH OS-O1-2002 FILE NUMBER 21 02-0534 .1~, COUNTY CUMBERLAND EARL RICHARD ETZWEILER ACN 101 ETZWEILER 8 ASSOCS Amount Remitted 105 N FRONT ST HBG PA 17101 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR_YOUR RECORDS___~ ----~-~... :.....,..erurur el 1 BWANCI REV-1547 EX AFP IUYVLJ nvl+..c ... - DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT 0 ESTATE OF SHAFFER JARVIS K FILE N0. 21 02-0534 ACN 101 DATE 09-30-2002 TAX RETURN HAS: ( )ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE (NATION CONCERNING FUTURE INTEREST - aec Iccrcna~ 1ISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest [Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F] 7. Transfers (Schedule gJ B. Total Assets (1) .DO NOTE: To insure proper (27 ,00 credit 4o your account, 137 ,00 submit 4he upper portion (47 .00 of this Porn with your 157 ,QO tax payment. (e) .00 (7) 168.333.92. (B) 168,333.92 APPROVED DEDUCTIONS AND EXEMPTIONS: 643. 00 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 00 30 Debts/Mortgage Liabilities/Liens (Schedule I) ( 10) . 00 643 . I11) . 11. Total Deductions (127 167,690.92 12. Net Value ofi Tax Return J] l .00 ritable/Governmental Bequestsi Non-elected 9113 Ch e Trusts (Schedu ( 4) 92 690 167 13. a . , 14. Nst Value of Estate Sub3ect to Tax NOTE: If an assessment was issued previously, lines 14, 15 and/or sess 16, 17, ed to da 18 and 19 will te. reflect figures that include the total of ALL returns as ASSESSMENT OF TAX: 167,690.92 X 00 = .00 15. Amount of Line 14 at SDOUSal rate (157 00 045 = .00 A rake l (16] . X 16. ass Amount of Lins 14 taxable at Lineal/C 00 12 - .00 (177 _ X 17. Amount of Line 14 at Sibling rate 00 15 = .00 ss B rate l/Cl t (1B) . X 18 a era Amount of Line 14 4axable at Colla ,00 . (19)= 19. Principal lax Due ^ IF PAID AFTER DATE INDICATED, SEE REVERSE f IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUOURMAV BE DUE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) FEV46i6 E%(686) I COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES f1FPT. 280601 ITEM SCHEDULE NO. H ~ B-3 Daniel Heck Shaffer, Jarvis K. INHERITANCE TAX EXPLANATION OF CHANGES 2102-0534 101 EXPLANATION OF CHANGES The claim for family exemption cannot be made against non-probate assets as exemption comes from Chapter 31 of the Probate, Estates and Fiduciary Code. ROW Page 1 1 f ~' L~.`; STATUS REPORT UNDER RULE 6.12 Name of Decedent: Jarvis Kenneth Shaffer Date of Death: Ma 1 2002 Admin. No. Will No. 2002-00534 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the follo~~ ing with respect to completion of the administration of the above-captioned estate. State whether administration of the estate is complete: Yes X No. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3, If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No. X b, The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes X No. d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. ~. F Dated: 10/21/2007_ B Signature Earl Richard Etzweiler, Esquire 105 North Front Street Harrisburg, PA 17101 (717) 234-5600 Capacity: Personal Representative X Counsel for personal representative ~ {f, CU tY~ ~r-~G r~U CU ~"n~ ~' 1 STATUS REPORT UNDER RULE 6.12 Name of Decedent: Date of Death: ~" - _ ~-~r~~J Will No. ~GO~_oG53~1 Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate. 1. State whether administration of the estate is complete: Yes X No. 2, If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3, If the answer to No. 1 is Yes, state the following: a, Did the personal representative file a final account with the Court? Yes No. X b, The sepazate Orphans' Court No. (if any) for the personal representative's account is: c, Did the personal representative state an account informally to the parties in interest? Yes .~._ No. d acocolunts may be filedewith thenClerk of the Orphans' C urt and maynbe attached to this report. Dated: y'3 _C~ Siguature Earl Richard Etzweiler, Esquire 105 North Front Street Harrisburg, PA 17101 (717) 234-5600 Capacity: Personal Representative X Counsel for personal representative