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HomeMy WebLinkAbout09-24-14 1505610105 REV-1500 EX(m—ii)(FI) OFFICIAL USE ONLY PA Department of Revenue pennsylvania �EVIPixEN•OE FEvfxUE County Code Year Flle Numbe11 r Bureau of Individual.Taxes INHERITANCE TAX RETURN """ PO BOX 28o6oi ! �` ; Harrisburg,PA 17128-o6oi RESIDENT DECEDENT �� 7y ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 07/14/2014 06/01/1927 _._...� ..................._..._. �........_..._....... ..... ..... Decedent's Last Name Suffix Decedent's First Name MI _........ ... .. _................................................... ........ .. SHAFFER LUCILLE M ......... .. (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI i r.......... _ .. ... .. ......__ __.._ Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW (3@D 1.Original Return O 2.Supplemental Return C7 3. Remainder Return(Date of Death Prior to 12-13-82) O 4.Limited Estate O 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82) OD 6. Decedent Died Testate O 7.Decedent Maintained a Living Trust 8. Total Number 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 to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number E.E. MANBECK REGISTER WILLS USE 5BLY �7 s M First Line of Address [=J .........._...... . _.,._... _...,,.. .....—._..r I e 3812 Second Line of Address HEARTHSTONE ROAD .____.__.. . __..�. _�__._.. -.__._......._...___._.__ .__. . .,,_.__... ...,..._.,,_.� DATE"FILED City or Post Office State ZIP Code rT1 ��.. ._. ._�... _......_...__................... ...... .............. ____�_..�........._......., ...,,,,.. I— CD CAMP HILL PA 17011 too Correspondent's e-mail address: 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 true,correct and complete.Declarytion of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATU F ERSON ESPO IBLE FOR FI ING RETURN DATE ADDRESS• e/ j SIGNATURE OF PREPARER OTHER T 4 R RESENTATIVE d DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 �J 1505610205 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: LUCILLE M. SHAFFER RECAPITULATION ........_.........._.........._................_......._..._......-...__.....__......._...-.-....................-.-........... _........_.__ i 1. Real Estate(Schedule A). ............................................ 1. 118,500.00 2. Stocks and Bonds(Schedule B) ....................................... 2. j 45,564.00 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. + i 4. Mortgages and Notes Receivable(Schedule D) ........................... 4. I 5: .Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 131,369.12 6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. . 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property I (Schedule G) O Separate Billing Requested........ 7. ( f 8. Total Gross Assets(total Lines 1 through 7)................ ............. 8. f 295,432.12 .! 9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. j 28,881.16 I 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)................ 10. 3,723.43 11. Total Deductions(total Lines 9 and 10)....................... .......... 11. 32,604.59 i ,,12. Net Value of Estate(Line 8 minus Line 11) .................... .......... 12. ! 262,827.53 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) . ....................... 13. i 10,000.00 14. Net Value Subject to Tax(Line 12 minus Line 13) ......................... 14. E 252,827.53 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,,or transfers under Sec.9116 �_.................__..... ......._._............_._......__............_....._............. .......__..........._......... _.... ...i _.__...... ..._ ._._...---... ...._._....------------........_._..........__.... (a)(1.2)X.0_ 15. 1 16. Amount of Line 14 taxable i at lineal rate X.0_ 16. .17. Amount of Line 14 taxable at sibling rate,X.12 i 252,573.53 17. i 30,308.82 18. Amount of Line 14 taxable at collateral rate X.15255.00 j 18 I 38 25 ..._....._......_......_............_........ ................ ..._._........ __..........-....... i 19. TAX DUE ......................................................... 19. E 30,347.07 I 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 L 1505610205 1505610205 REV-1 500 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME LUCILLE M. SHAFFER STREETADDRESS 117 EASTERLY DRIVE CITY STATE ZIP MECHANICSEURG PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 30,347.07 2. Credits/Payments A.Prior Payments B.Discount 1,577.35 Total Credits(A+B) (2) 1,517.35 3. Interest (3) 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2,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) 28,829.72 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.......................................................................................... ❑ N b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ c. retain a reversionary interest.............................................................................................................................. ❑ d. receive the promise for life of either payments,benefits 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? ........................................................................................................................ ❑ 0 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 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 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 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 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(a)(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(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 common with the decedent,whether by blood or adoption. REV-1502 EX+(12-12) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: LUCILLE M. SHAFFER 2120140701 All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,bath having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1. 'SINGLE-FAMILY CONDOMINIUM,117 EASTERLY DRIVE,MECHANICSBURG,PA 118,500.00 2. TAX NUMBER-23-0571-190-U9 3. SALE PRICE REPORTED-SEE ATTACHED SETTLEMENT SHEET TOTAL(Also enter on Line 1, Recapitulation.) $ 118,500.00 If more space is needed,use additional sheets of paper of the same size. \ OMB Approval No.2502-0265 A- Settlement Statement (HUD-1) B.Type of Loan 1.❑FHA 2.❑RHS 3.❑Conv.Unins. 6.File Number: 7.Loan Number: 8.Mortgage Insurance Case Number: CHM-01157 000082112 4.❑VA 5.❑Conv.Ins. C.Note:This forth is furnished to give you a statement of actual settlement costs.Amounts paid to and by the settlement agents are shown.Items marked '(p.o.c)'were paid outside the dosing;they are shown here for Informational purposes and are not Included in the totals. D.Name&Address of Borrower: E.Name&Address of Seller: F.Name&Address of Lender. VIRGINIA RAE MAROUART THE ESTATE OF LUCILLE M.SHAFFER HomeSale Mortgage,LLC 36 Tory Circle,Enola,PA 17025 215 S.Centerville Road,Lancaster,PA 17603 G.Property Location: H.Settlement Agent: I.Settlement Date:09/12/2014 117 EASTERLY DRIVE,SILVER SPRING Homesale Settlement Services Disbursement Date:09/12/2014 TOWNSHIP 4000 Crums Mill Road,Suite 101,Harrisburg,PA 17112 MECHANICSBURG,PA 17055 Silver Spring Township 717-671-9876 Place of Settlement: TitleExpress BHHS HomeSale Services,3435 Market Street Camp H11, Printed 09/10/2014 at 10:27 am PA 17011 by SH J.Summary of Borrowees Transaction K Summary of Sellees Transaction 100. Gross Amount Due from Borrower 400. Gross Amount Due to Seller 101. Contract sales price 118,500.00 401. Contract sales price 118,500.00 102. Personalproperty'^ 402. Personal property s 103. Settlement charges to borrower(fine 1400) 3,080.17 403. 104. 404. . 105. 405. Adjustments for Items paid by sailor in advanee Adjustments for items paid by seller in advance s -106. Cityltown taxes to 406. Cilyftown taxes to 107. County taxes 091122014 to 12/312014 114.30 407. County taxes 09/1212014 to 12/312014 114.30 10& School taxes 09/12/2014 to 06130/2015 805.61 408. School taxes 09/12/2014 to 06/302015 805.61 109. Ouartedy HOA Dues 09/122014 to 0913012014 51.63 409. Ouartedy HOA Dues 09112/2014 to 09/30/2014 51.63 110. Trash 09/12/2014 to 09/302014 7.88 410. Trash 09112/2014 to 09/302014 7.88 111. 411. 112 412. 120• Gross Amount Due from Borrower 122,559.59 420. Gross Amount Due to Seller 119,479.42 200. Amounts Paid by or in Behalf of Borrower 500. Reductions In Amount Due to Seller 201. Deposit or earnest money 2,000.00 501. Excess deposit(see instructions) 202 Principal amount of hew loans) 94,800.00 502 Settlement charges to seller Qine 1400) 8,296.88 203. Existing loan(s)taken subject to 503. Existing loan(s)taken subject to 204, 504. Payoff of first mortgage loan 205. 505. Payoff of second mortgage loan 206. 506. i 207. 507• 208. SellerAssisl 400.00 508. Seller Assist 400.00 209. 509. Adjustments for items unpaid by seller Adjustments for Items unpaid by seller 210. City/town taxes to 510. Cityltown taxes to 211. County taxes to 511. County taxes to '212 School taxes to 512 School taxes to 213. 513. ` 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. Total Paid by/for Borrower 97,200.00 520. Total Reduction Amount Due Seller 6,696.88 300. Cash at Settlement fromlto Borrower 600. Cash at Settlement tolfrom Seller 301, Gross amount due from borrower(line 120) 122,559.59 601. Gross amount due to seller(line 420) 119,479A2 302 Less amounts paid by/fa borrower(line 220) 97,200.00 602 Less reductions in amount due seller(line 520) 8,696.88 303. Cash ❑X From ❑ To Borrower 25,359.59 603. Cash ❑X To' ❑ From Seller 110,782.54 •'YY bm,.uYu�d,dl��an✓MMC01.®mW,wniEe.IIO wrMWrtlRyb Hw�O:WOEow�b,-MSM'.TN�bbgmObpnAO�Mo��bi RESP�m+Itl enuefen MN Hwm�Ib,ON'gM . �MNw-1MpacM. Previous'editions are obsolete Page 1 of 4 HUD-1 700. Total Real Estate Broker Fees $5,925.00 Paid From Paid From Division of commission yine 700 as follows: Borrower's Seller's 701• $2,666.25 to Remax tat Advantage Funds at Funds at 702 $3,258.75 to Berkshire Hathaway HomeServices Settlement 'Settlement 703. Commission paid at settlement 5,925.00 7D4. Broker Fee to Berkshire Hathaway HomeServices 225.00 800. Items Payable In Connection with Loan 801. Our origination charge (Includes Origination Point 0.000%or$0.00) $ (from GFE#1) 802. Your credit or charge(points)for the specific Interest rate chosen $ (from GFE#2) 803. Your adjusted origination charges (from GFE A) 804. Appraisal fee to (from GFE#3 805. Credit report to from GFE#3 806. Tax service to from GFE 93 807. Flood certification to from GFE#3 808. to 900. Items Required by Lender to be Paid In Advance 901. Daily interest charges from from 09/12/2014 to 10/0112014 @$0.00/day (from GFE#10) v, 902 Mortgage insurance premium months to (from GFE#3 M. Homeowner's insurance months to from GFE#11 904. months to (from GFE#11) 1000. Reserves Deposited with Lender• 1001. Initial deposit for your escrow account (from GFE#9) 1002 Homeowners insurance months @$' /month 1003. Mortgage Insurance months @$ /month 1004. Property taxes months @$ /month 1005. County(axes mohths @$ 31.32/month $ 1006. School Taxes months @$ 83.92tmonth $ 1007. Aggregate Adjustment $ 1100. Title Charges 1101. Title services and lenders title Insurance (from GFE#4) 1,315.50 1102..Settlement or dosing fee to $ 1103. Owners fi0e insurance-Old Republic Tide Insurance Company (from GFE#5) 122.50 1104. Lenders 011e insurance-Did Republic Tithe Insurance Company $1,197.50 1105. lenders title policy limit$94,800.00 Lenders Policy ,1106. Owners 011e policy limit$118,500.00 Owners Policy 1107. Agent's portion of the total 1109 insurance premium $1,063.55 to Homesale Settlement Services 1 f08. Underwriters portion of the total title Insurance premium $256.45 to Old Republic Tide Insurance Company 1109. 1200. Government Recording and Transfer Charges 1201. Government recording charges $ (from GFE#7) 194.00 1202• Deed$81.00 Mortgage$113.00 Release$ 1203. Transfer taxes $ (from GFE#8) 1,185.00 1204. City/County tax/stamps Deed$1,185.(10 Mortgage$ 1205. State Tax/stamps Deed$1,185.00 mortgage$ 1,185.00 1206. Deed$ Mortgage$ 1300. Additional Settlement Charges 1301. Required services that you can shop for (from GFE#6) 1302. to $ 1303. 2014 School Taxes to Debra Basehore Wiest,Tax Collector 1.007.01 1304. Tax Certification to Homesale Settlement Services 20.00 1305. Notary Fee to Notary Public 12.00 1306. Resale Cert to Tracy Weigel r�0 1307. Trash 1011114 to 12131114 to Penn Waste 38.17 1308. Sewer 711114 to 9112/14 to Silver Spring Township Authority 97.8 MEVIIIIIIIIIII3,080.171 8,296.88 'Paid outside of dosing by(B)onower,(S)eller,(L)ender,(I)nvestor,Bro(K)er."Credit by lender shown on page 1."'Credit by safer shown on page 1. Previous editions ate obsolete Page 2 of 4 HUD-1 % Comparison of Good Faith Estimate(GFE)and HUDA Charges Good Faith Estimate HUD-1 Charges That Cannot Increase HUD-1 Line Number Ouroriginatiorri charge # 801. 0.00 0.00 Your credit or charge(points)for the specitic Interest rate chosen # 802 0.00 0.00 Your adjusted origination charges. #803 0.00 0.00 Transfer lazes #1203 0.00 1,185.00 Charges That In Total Cannot Increase More Than 10% Good Faith Estimate - HUD-1 Government recording charges #1201 0.00 194.00 Title services and lender's tide insurance #1101 0.00 1,315.50 Owners litle insurance #1103 0.00 122.50 #1302 0.00 0.00 ... .. - # - #, 0.00 1,632.00 r $1,632.00 or 999.9999% Charges That Can Chance Good Faith Estimate HUD-1 Initial deposit for your escrow account #1001 0.00 0.00 Daily interest charges from , #901 $ /day 0.00 0.00 Homeowners insurance #903 0.00 0.00 ... .... ... # . Loan Terms Your initial loan amount is $ Your loan term is years Your initial interest rate is % Your initial monthly amount owed for principal,Interest,and any mortgage - $ Includes nsurance is ❑Principal ❑Interest - ❑Mortgage Insurance Can your Interest rate.rise? X❑No. ❑Yes,it can rise to a maximum of %.The first change will be on I I and can change again every years after I I .Every change date,your interest rate can increase or decrease by %.Over the life of the ban,your Interest rate Is guaranteed to never be lower than %or higher than %. Even if you make payments on time,can your ban balance rise? FAINo. ❑Yes,it can rise to a maximum of$ Even 9 you make payments on time,can your monthly amount owed for X❑No. ❑Yes,the first increase can be on / / and the monthly prindpal,interest and mortgage insurance rise? amount awed can rise to S The maximum it can ever rise to is$ Does your ban have a prepayment penalty? ❑X No. ❑Yes,your maximum prepayment penalty is$ Does your loan have a balloon payment? ❑X No. ❑Yes,you have a balloon payment of S due In years on I I Total riionthtyamount owed including escrow account payments Q You do not have a monthly escrow payment for Items,such as property taxes and homeowners Insurance.You must pay these items directly yourself. ❑You have an additional monthly escrow payment of$ that results in a total Initial monthly amount owed of$ This includes principal,interest, any mortgage Insurance and any Items checked below: ❑Property taxes ❑Homeowners Insurance _." ... ❑Flood Insurance ❑ ._ ..::. .. - ❑ ❑ Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form,please contact your lender. Previous editions are obsolete Page 3 of 4 HUD-1 REV-1503 EX+(8-12) pennsylvania SCHEDULE B ' DEPARTMENT OF REVENUE INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER LUCILLE M. SHAFFER 2120140701 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1' $10,000.00 U.S. SERIES EE BOND X5249229EE 10,012.00 :ISSUED 07/14/1997-POD DAVID SHAFFER (SEE ATTACHED CALCULATION) 2 $10,000.00 U.S.SERIES EE BOND X4971340EE 10,088.00 ISSUED 08/28/1990-POD NORMAN MANBECK (SEE ATACHED CALCULATION) 3 $10,000.00 U.S.SERIES EE BOND X5046513EE 10,056.00 ISSUED 01-15-1997-POD LEROY MANBECK (SEE ATTACHED CALCULATION)" 4 $10,000.00 U.S.SERIES EE BOND X2161150EE 15,408.00 ISSUED.02-11-1992-POD LEROY MANBECK (SEE ATTACHED CALCULATION) TOTAL(Also enter on Line 2, Recapitulation) $ 45,564.00 If more space is needed,insert additional-sheets of the same size r -------- -- iii�`wp Yt ujii I '.'0 6 M?d:b! 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' E 8/20/2014 Calculated Value of Your Paper Savings Bond(s) Calculated Value of Your Paper Savings Bond(s) Calculator Results for Redemption Date 08/2014 Total Price Total-Value TotalInterest YTD Interest 20,000.00 $45,564.00 $25,564.00 $3,676.00 Bonds: 1-4 of 4 Issue Next Final Interest: Serial # :Series: Denom : :Issue Price : Interest - Value �Note' Date Accrual Waturity, Rate X5249229EE: EE _$10,000;07/1997_09/2014 07/2027: $5,000.00: $5,012.00; 1.42%;$10,012.00; X4971340EE: EE__ $10,000:08/199602/2015 _08/2026; $5,00000 _$5,08800 134% $10,088.00: ; : , , ~X2161150EE; EE w$10,00002/1992:02201502/2022; $5,000.00 $10408 00: 4.00% $15,408.00; / ; , : $10,000:01/1997012015012027: 5X54653EE; u : / : 01.34%:$10,056.00; Totals for 4 Bonds; 20 000.00; 25 564.00 4--5-,-S-64.00' NI 'Not Issued , NE :Not eligible for payment PS ;Includes 3_month interest penalty........... MA ;Matured and not earning interest http:/twmNtreasurydirect.gov9BC/SBCPrice 1/1 REV-1508 EX+(08-12) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: LUCILLE M. SHAFFER 2120140701 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. MEMBERS 1ST FEDERAL CREDIT UNION-ACCOUNT NO. 577, (SEE ATTACHED) 66,177.52 2. M&T BANK-ACCOUNT NO. 76925838,(SEE ATTACHED) 28,243.16 3. RIVERVIEW BANK-ACCOUNT NO.065347, (SEE ATTACHED) 30,720.25 4. HOUSEHOLD FURNISHINGS-APPRAISAL VALUE 1,020.00 5, 2009 BUICK-SALE PRICE REPORTED 5,000.00 6. ERIE INSURANCE COMPANY-INSURANCE CANCELLATION 208.19 TOTAL(Also enter on Line 5, Recapitulation) $ 131,369.12 If more space is�heeded,use additional sheets of paper of the same size. © M8T 499 Mitchell Road,Millsboro,DE 19966 Records Management Phone 888-502-4349 F ax (302)934-2955 July 30,2014 John M. Eakin Market Square Building 1 W. Main Street Mechanicsburg, PA 17055 Re: Estate of Lucille Shaffer Social Security: 202-20-3803 Date of Death: July 19,2014 Dear Sir or Madam: Per your inquiry on July 28,2014,please be advised that at the time of death,the above-named decedent had on deposit with this bank the following: 1. Type of Account Checking Account Account Number 76925838 Ownership(Names of Ruth R Hill(POA) Lucille Shaffer Opening Date 08/28/1967 Balance on Date of Death $ 28,243.16 Accrued Interest $ .08 --------------- - - ------------- ------- ---------------------------- Total $28,243.24 r For any additional information on the above accounts,including ownership and any changes,closures and/or reimbursement of funds, please call the Mechanicsburg at 717-697-1515. We were unable to locate any safe deposit box for the above-mentioned decedent. This letter does not include any accounts in which the deceased may have been listed as Power of Attorney,Custodian of Uniform Transfers, Representative Payee,or Trustee under a Written Agreement Sincerely, Valarie Mercer Records Management 4. MEMBERS of ' 'Pd3tsFsX#,,At,!C;i+Y�r➢a`t'1Ctl'+1't�)�t Market Plaza 4 Market Plaza Way Mechanicsburg PA 17055 Inquiries Call: 717-697-1884 Acct XXXXXXX577 SHAFFER,LUCILLE Eff: 07/28114 Date: 07128/14 Tlr: 0382 Time: ll:29am a Withdrwl from REGULAR SAVINGS 0000 Prev Bal: 66,177.52 Amount: 66,177,52 Now Bal: 0.00 Seq: #336857 Check Disbursed -66,177.52 THE ESTATE OF LUCILLE SHAFFER Ref number: 00 935617 Authorized by ID Source: ❑ Dry Lic ❑ SigCard ❑ Known ❑ Other VISA Balance Transfer 1,90% APR NO balance transfer fees. Ask an associate for more details. LUCILLE M SHAFFER RIVERVIEW BANK AND ITS OPERATING DIVISIONS 303529 HALIFAX BANK•MARYSVILL.E BANK REMITTER .PA 3 �+`,! '• 60.1239/006 010006 DATE PAY TO THE `I ;h9 rJ:.rin4%rfi ki^Ani-rr,t• �" - E:�°�ik1:�� a �,.l.I�;IIL�;� .-t;..l,:i'fi�r:�i ORDER OF ::,h'::r••-intt3f 1.- r•' .,,l....A-,t','�irr�r4 ... .. 1... i7 i 11.', 1 !11!. L,I r,<r f i j '; 'i P l=i i i 'i l i(a i..f I Ta'I.i i li�i F-j"fi? i({ DOLLARS e " THIS DOCUMENT HAS A MICRO-PRINT SIGNATURE LINE,WATERMARK AND A THERMOCHROMIC ICON;ABSENCE OF THESE FEATURES WILL INDICATE A COPY CASHIER'S CHECK �L. n�J(arix_ NP 0 30B 5 29n' 1:03131239131: 0 L111 0 0 0 111 6 11' REV-1511 EX+ (10-09) -' SCHEDULE H pennsylvania DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER LUCILLE M. SHAFFER 2120140701 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' ROLLING GREEN CEMETARY 1,495.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 10,000.00. Name(s)of Personal Representative(s).E.E. MANBECK Street Address 3812 HEARTHSTONE ROAD City CAMP HILL State PA ZIP 17011 Year(s)Commission Paid: 2014 2• Attorney Fees: 10,000.00 3. Family Exemption: (If decedent'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: 5. a,._,...ntant Fees: 6. Tax Ret8rn PFePaFeF Fees! 7. ESTATE NOTICES: CUMBERLAND LAW JOURNAL-ESTATE NOTICE 75.00 SENTINEL-ESTATE NOTICE 201.16 8. COST OF SELLING REAL ESTATE: REALTOR COMMISSION 5,925.00 1%TRANSFER TAX 1,185.00 TOTAL(Also enter on Line 9, Recapitulation) $ 28,881.16 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+ (12-12) r pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER LUCILLE M. SHAFFER 2120140701 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 8/8-WESTFIELD CONDO ASSOCIATION 250.00 2. 8/9-PINNACLE HEALTH HOSPITAL 63.24 3. 8/17-HOSPICE 2,250.00 4. 8/17-UNITED WATER 24.09 5. 8/17-PP&L 73.44 6. 8/21 -DEBRA WEIST-TAX COLLECTOR(SCHOOL TAX) 986.87 7. 8/22-UNITED WATER 11.62 8. 8/23-PP&L 64.17 TOTAL(Also enter on Line 10, Recapitulation) $ 3,723.43 If more space is needed,insert additional sheets of the same size. REV-1513 EX+(01-10) i pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: LUCILLE SHAFFER 2120140701 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(Include outright spousal distributions and transfers under Sec.9116(a)(1.2).] 1. Edwin Manbeck,921 Greenbriar Drive,Mechanicsburg PA 17055 Brother 25%of residue 2. Ruth Hill,.53 Keswick Drive,Mechanicsburg,PA 17055 Sister 25% of residue 3. Norman Manbeck,61 Northview Drive,Mechanicsburg,PA 17055 Brother 25%of residue 4. Leroy Manbeck,3 Kensington Drive,Camp Hill,PA 17011 Brother 25% of residue 5. E. E.Manbeck,3812 Hearthstone Road,Camp Hill, PA 17011 Nephew $255.00 bequest 6. Mt.Zion United Methodist Church,Wertzville Road,Enola, PA 17025 $10,000.00 bequest 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 SECTION 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. e REV-1513 EX+ (01-10) 7 pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: LUCILLE SHAFFER 2120140701 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(Include outright spousal distributions and transfers under Sec.9116(a)(1.2).) 1. Edwin Manbeck,921 Greenbriar Drive, Mechanicsburg PA 17055 Brother 25% of residue . 2. Ruth Hill,`53 Keswick Drive,Mechanicsburg,PA 17055 Sister 25%of residue 3. Norman Manbeck,61 Northview Drive, Mechanicsburg, PA 17055 Brother 25% of residue 4. Leroy Manbeck,3 Kensington Drive,Camp Hill,PA 17011 Brother 25%of residue 5. E. E.Manbeck,3812 Hearthstone Road,Camp Hill,PA 17011 Nephew $255.00 bequest 6. Mt.Zion United Methodist Church,Wertzville Road,Enola,PA 17025 $10,000.00 bequest 3 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 SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: . 1 TOTAL OF PART n— 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.