HomeMy WebLinkAbout04-15-05
ReV.lIiOOElC.(f.OOl
'.
COMMONWEALTH OF PENNSYlVANIA
OEPAF'l:TMENT OF REVENUE
DEPT. 2'80601
HARRISBURG. PA 17128-0601
~? REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
'--------J-
-----
~
z
'"
o
'"
c
w
o
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Capehart, Joan E.
DATE OF DEATH (MM-OO.-\,'EI\R)
DATE OF BIRTH (MM-[ID.'fEAR)
0112412005
0112011939
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST AND MIDDLE INITIAL)
OF'F!'::;I!,L (tSi,'(j:'jl.'
FILE NUMBER
21 05
COUNTY CQP~ YEAR
SOCIAL SECURITY >>UMBER
0113
NUMBER
198-30-1405
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAl SECURITY NUMBER
Capeh.,1, Paul E.
t8I 1. Original Relum 0 2. Supplemental Return 0 3. Remalnder Return (dale 01 death prklr to 12-13-82)
I!!
~ :$ U) 0 4. Limited Estate 0 4a. Future Interesl Cornpromiss (date of death aller 0 5. Federal Eslate Tax Return Required
&llf~ 12-12-82)
G ~ 9 ~ 6. Decedent Died Testate (Atle.ctl copy 0 7. Decadent Maintained a Ll'Ving TrusttAllaCh 0 8. Total Number of Safe Deposit Boxes
8: III of Will) copy of Trust)
0( 0 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (date otdaalh between 0 11.Election to tax under Sec. 9113(A) (A.ttacl\ SehO)
THJI3_SECTlOI'Mtl[t,~~i!::,gr.l.~g~i~P'L~l?,~!t~jJ.tl~!!L~~~__~~]!~~_~)~~f.;;J;_ :1';}l~Ji;i
NAME COMP\.ETE MAILING ADDRESS
~ Dale F Shughart, Jr. Esquire
~ FIRM NAME (tl applicable)
z
:<
"TElEPHONE NUMBER
7171241-4311
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3_ Closely Held Corporation. Partnership or Sole.Proprietorship
z
o
F
~
~
~
"
~
(i\
~
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
(Schedule G or L}
B. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debls ot Decedent, Mortgege Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value 01 Estate (Line Bminus Line 11)
35 E. High Street, Suite 203
Carlisle, P A 17013
(1) None
(2) None
(3) None
(4) None
(5) 4,849.11
(6) None
(7) 70,224.32
(8)
(9) 9,465.27
(10)
{)I'FICIAL IISr: IOf.jLY
C::J
75,073.43
(11)
9,465.27
65,608.16
(12)
(13)
13. Charitable and Governmental Bequests/See 9113 TNsts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Une 13)
(14)
65,608.16
SEE INSmUCTlONS ON REVERSE SIDE FOR APPUCABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate, 64,776.16 x ,00 (15)
or transters under Sec. 9116(a)(1.2)
z ,045 (16}
0 16. Amount of Line 14 taxable at Hneal rate x
F
.
~
~
~ 17. Amount of Une 14 taxable at sibling rate x _12 (17)
.
0
U
K 18. Amount of Une 14 taxable at collateral rate
;; 832.00 x .15 (18)
19. Tax Due (19)
0.00
124.80
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
124.80
- --~; il(sui'iET~AN~!iJi\l~U,,!M~]M''ilEY~~$.~:s.!!?!~Ng~c::liEo::K~A.1:H:::;::-;--';--;-~___... ..
Copyright 2000 form software only The Lackner Group. Inc.
0-
Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
927 Gobin Drive
CITY
Carlisle
STATE PA
ZIP 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
124.80
118.56
6.24
Total Credits (A + B + C)
(2)
124.80
3. InteresVPenalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E)
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
5. If line 1 + Line 3 is greater than line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
(3) 0.00
(4)
(5) 0.00
(SA)
(5B) 0.00
;.'.':::~::~.:0Y'i~~r~~~:i"
Make Check Payable to: REGISTER OF WILLS, AGENT
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred;..............................._........h......................................
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 uin 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? ......................................................................................................................
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
'~ i
o
181
181
~
o
o
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties 01 peljury, I cleClare that I have examIned this retum, Including accompanying sChedul95 and statements. and to the besl of my knowledge end belief, JI is true, correct
and complete. Declaration 01
preparer other than the personal representative is basad on all information 01 which preParer has any knOYdedge.
SIGNATURE OF PERSON RESPONSIBLE FOR FlUNG RETURN ADDRESS
P,ul E~.rt U /c./ / "'- ~
SJGNA~~eS~.l~~R~N
927 Gobin Drive
Carlisle, P A 17013
Lf!;A~/'b~;-
ADDRESS
DATE
ADDRESS
35 E. High Street, Suite 203
Carlisle, PA 17013
DATE
W/iIIJS
For dates 01 death on or er 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 P.S. !i9116 (.) (1.1) (i)].
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 O%.
[72 P.S. 99116 (a) (1.1) (1)]. The statute does not exemot 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 for the use of a natural
parent. an adoptive parent, or a stepparent of the child is 0% [72 P .5. ~9116 (a) (1.2)1.
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%. except as noted in 72 P.S. 99116
1.2) (72 P.$.!i9116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% 172 P .8. 99116 (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.
ESTATE OF
'.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM
NUMBER
I
2
3
4
COWMOlIIWEAlTli OF PENNSYLVANIA
INHEAlTANCE TAX RETURN
RESIDENT DECEDENT
Capehart, Joan E.
FILE NUMBER
21-05-0113
VALUE AT DATE OF
DEATH
424.00
408.00
2,500.00
1,517.11
4,849.11
DESCRIPTION
Ladies engagement ring, .04 karat diamond, 14 karat gold mount, specifically bequeathed to Judith
Clippinger Largent, value based upon attached appraisal of Henry Line.
Ladies garnet and .04 karat diamond ring, on ] 5 karat gold mount specifically bequeathed to Cheryl C.
Warner, value based upon attached appraisal of Henry Line.
Miscellaneous personal effects and jewelry not specifically bequeathed.
Eight $25.00 U.S. Series E Savings Bonds issued to Joan E. Peterson (now Capehart). Pay on death to Mr.
George I. Peterson, Father ofJoan (Peterson) Capehart who died on July 30, 1973. Value based upon
attached itemization.
TOTAL (Also enter on Line 5, Recapitulation)
..
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Capehart, Joan E.
. FILE NUMBER
21-05-0113
ITEM
NUMBER
This schedule mu~t becomp!et8<l a.I'ld,f.llecl.lf..tllea"s",.ert()e_"Y.c:>fqu~"tl(),,,sJ.througll.4..o.,,'p...g,e.2Js yes.
DESCRIPTION OF PROPERTY % OF .
Indude the name oIlhe ll'8Jlsferee, their relallonshlp to dececlent and the dale of transfer. . DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE
Attach a cOP)'of the cI8ed for real eslate .VALUE OF ASSET (IFAPPUCABLEl
; INTEREST
i.-,.,-~_
_n .___,,-.... __'_' __'__'___
Thrift Savings Plan through FERS, value in accordance with
attached letter from Reginald G. Hargettchief.
Beneficiary: Paul E. Capehart, husband
19,755.57
100%
2
Members I sl Federal Credit Union IRA, valued in
accordance with attached statement from Members 1st.
Beneficiary: Paul E. Capehart, husband
28,260.02 100%
3
156 $25.00 Series E. U.S. Savings Bonds
Owner: Mrs. Joan E. Capehart
Pay on Death: Paul E. Capehart, husband
DOD value based upon attached compilation of bonds and
redemption values.
22,208.73 100%
,
".
,
,
,
TOTAL (Also enter on line 7, Recapitulation)
19,755.57
28,260.02
22,208.73
70,224.32
*'
SCHEDULEH
R.JIIERALEXPENSES &
ADMNSTRA11VECOSTS
CQMIolONWEAtlH OF peNNSYlVANIA
INHERITANCE TAX RE1\.IRN
RESIDENT oeceDENT
ESTATE OF
Capehart, Joan E.
FILE NUMBER
21-05-0113
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
Hollinger Funeral Home, cremation and service
2,239.50
2
St. Paul's Lutheran Church, honorariums and family meal.
400.00
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
B.
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City State Zip
Year(s) Commission paid
Attomey's Fees Dale F. Shughart, Jr., Esquire, estimated
3.
Family Exemption: (If decedent's address is not the same as clalmanrs, attach explanation)
Claimant Paul E. Capehart
Street Address 927 Gobin Drive
Carlisle
3,000.00
3,500.00
2.
State PA
Husband
Zip
17013
City
Relationship of Claimant to Decedent
4.
Probate Fees
30.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 Register of Wills, Short Certificates 8.00
2 The Sentinel, advertising Letters 129.77
Total of Continuation Schedule(s)
TOTAL (Also enter on line 9, Recapitulation)
158.00
9,465.27
'.
ScI1ecJIje H
A.rIer.II Expel s e s &
Ad ._1 iltlcdilie CosIs conIiruld
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
. _--"__0--.___ _____..____,_ ,.
-. -
ESTATE OF
Capehart, Joan E.
3
Cumberland Law Journal, advertise Letters
4
Henry Line, ring appraisal
5
Hollinger Funeral Home, Death Certificates for George I. Peterson
6
Posttnaster, certified mail
FILE NUMBER
21-05-0113
Page 2 of Schedule H
75.00
53.00
25.00
5.00
REV-1513 EX+ (9-00)
.
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDEONT
ESTATE OF
Capehart, Joan E.
; FILE NUMBER
21-05-0113
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
RELATIONSHIP TO
DECEDENT
. _ _--Oo.Not Llat TlLlstee(a'"
AMOUNT OR SHARE
OF ESTATE
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
Judith C. Largent
15 Chelsea Lane
Carlisle, PA 17103
Niece
IRing valued at $424.00
2 Cheryl C. Warner
4 Erin Place
Carlisle, PA 17013
; Niece
:Ring valued at $408.00
3 Paul E. Capehart
927 Gobin Drive
Carlisle, PA 17013
Husband
'Entire residue
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
\ II'
" \ \ /,
'~/
Z-., z-' ,
- .,,' . , - -,' .
=_;;~/iIJ LtC ....' ,'-.JI'/U!
1{;"~'1' i;;
. iI' '. ~t
iiA, t.' I
"C.'. ."J.
'~':, ~':
:J
~
Watchmakers . Jewelers
21 Dickinson Avenue . Carlisle, PA 17013-2903
(717) 249-3928 . Fax (717) 243-2623 . Toll Free 1-877-476-4877
APPRAISAL
FebruaryU, 2004
To Whom It Mav Concern:
This is to certify The following described jewelry items, property of Mr. Paul Capehart,
927 Gobin Drive, Carlisle, PA 17013, have current retail values, as listed below:
1. Ladies engagement style illusion set diamond ring consisting of a single cut diamond
weighing.04 carats, of GIA color grade, E and clarity grade VVS-l, the mounting
being of 14 karat two-tone gold value, as itemized below, ........ ......... ..... .$424.00.
.04 carat diamond @ $1,200.00 per carat......... ....$24.00
14 karat gold mounting...... ........................ ....$400.00
$424.00
2. Ladies garnet and diamond ring, consisting ofa centrally set oval shaped almandite
garnet measuring 7.0 mm. x 5.1 mm. of medium brown to red color, with eye visible
inclusions, the ring also having two single cut side diamonds, each weighing .02
carats, the mounting being of 14 karat yellow gold, value as itemized below,.$408.00.
Garnet................................................ ......... .....$114.00
Two diamonds total weight .04 carats @
$ 1,100.00 per carat...... ......... ...... ............ ......... ......$44.00
14 karat gold mounting...... ......... ...... ...... ............ ...$250.00
$408.00
TOTAL: $831.00
Line & Line Jewelers
.~/
L' ~
Henry lie
HLlsaa
Savings Bond Calculator
V.due As Of
1~.?{?o()5.~_.j
BOIHllnfu
Page I of 1
Savinc
1-
CALC~
1-
Series
1~~~I1~:;.__.
Re-:mlts
# Bonds
S
Denomination
Serial Number
Issue Date
$13.!i__.a
L_~~__._.__J
L..
...1
II
Total Price
5150.00
YTDln>
50.0
Total Interest
51,367.11
Total Value
51,517.11
Issue
Serial Number Issue Date Series Denom Price
Q1818467048E
Q1827549014E
Q1655247949E
Q 1683458967E
Q1687982454E
Q 1699957796E
Q 1807020367E
Q1668418659E
Le( end
Interest
Interest Next Final
Value Rate Accrual Maturi!}
03/2000
06/2000
12/1998
03/1999
06/1999
09/1999
12/1999
09/1998
03/1960 E $25 $18.75 $173.61 $192.36
06/1960 E 25 18.75 173.94 192.69
12/1958 E 25 18.75 170.59 189.34
03/1959 E 25 18.75 172.78 191.53
06/1959 E 25 18.75 169.13 187.88
09/1959 E 25 18.75 169.35 188.10
12/1959 E 25 18.75 169.75 188.50
09/1958 E 25 18.75 167.96 186.71
Note Description
NI Not Issued
NE Not Eligible for Payment
P5 Includes 3-month interest penalty
MA Matured and Not Earning Interest
Please rate this service.
(Please print andlor save this page before submitting your survey)
Service Excellent Good Fair Poor
Savings Bond Calculator
n
n
o
o
-
http://wwws.publicdebt.treas.gov/BC/SBCPrice
02/15/2005
**** *~
* ~
*
*
THR1FT
SAVINGS
PLAN
Thrift Savings Plan
National Finance Center
P.O. Box 61500, New Orleans, LA 70161-1500
March 10, 2005
Dale F. Shughart, Jr.
Attorney at Law
Suite 203
35 East High Street
Carlisle, PA 17013
Re: TSP account of
Joan E. Capehart,
Deceased
Dear Mr. Shughart:
This is in response to your letter dated February 22, 2005, to the
Thrift Savings Plan (TSP) Service Office requesting information
regarding the TSP account of Joan E. Capehart.
The TSP is one part of the retirement system created for Federal
employees in the Federal Employees' Retirement System Act of 1986.
(See 5 U.S.C. ~ 8351, 8401-79.) The TSP is a tax-deferred
retirement savings plan similar to those authorized under section
401(k) of the Internal Revenue Code for private sector employees.
The TSP began accepting contributions from Federal employees in
April 1987 and from members of the Uniformed Services in January
2002. As of the date of death, Ms. Capehart's TSP account balance
was $19,755.57.
We hope this information has been helpful.
Sincerely,
~~
/REGINALD G. HARGETT, Chief
Thrift Savings Plan Operations Branch
rIJ F (Y)1S F ~ I d ;::-C if
'0000053782 CAPEHART,JOAN E Share 10: IRA SAVINGS Transaction Summary
ID Elf Date Transaction Balance C... IntlPn... Fees New Balance Description/Pmt
S 10 01/31/2005 %% APY Earned 1.40% 01/01/05 to 01/31/05
S 10 01/31/2005 Dividend D... 33.33 0.00 0.00 28,267.55 1.390%
S 10 12/31/2004 %% APY Earned 1.25% 12/01/04 to 12/31/04
S 10 12/31/2004 Dividend D... 29.70 0.00 0.00 28,234.22 1.240%
S 10 11/30/2004 %% APY Earned 1.25% 11/01/04 to 11/30/04
S 10 11/30/2004 Dividend D... 28.72 0.00 0.00 28,204.52 1.240%
II
;)- r..J/y.. 3 '3 ' :3
'3 J ;:
iA R 1/1, 3 / 0 c C D 1./ - 1/ ;22/ :;.!' 1/. :J.- 'J.,
, ~ I_;;-I_~~ -. ;;5': &/02-
+ l-i-oC ..,lj d-g ;;.,fuo.O
p -fR l /
,
Page 1
02125/2005
Prev Available
28,234.22
28,204.52
28,175.80
st
Send Inquires to:
5000 Louise Drive
PO Box 40
Mechanic.burg, PA 17055
www.members1st.org
Main Switchboard: (71'7) 697-1161 or (800) 28a-.2328
EZ Call: (717) 697-4372 or (800) 283-4372
TOO: (717) 697-5312 or (BOO) 283-2328 ext. 5312
Tel_Branch: (717) 795-6049 or (800) 237-7288
MEMBERS 1st
FEDERAL CREDIT UNION
~
-
-
=
-
-
.
=
=
~
""""""
2099 1 AV 0.278 4197-2099
1...111...111..,...11.,11.,..11,1,1....11.11..,.1.11..,1.11,.1
JOAN E CAPEHART
C/O PAUL E CAPEHART
927 GOBIN ST
CARLISLE PA 17013-1516
Statement of Accounts
Gan 01,' ~005 ~u Jan 31, ~
Account Number: 53782
Account Balances at a Glance:
Checking: 0.00
Savings: 29,237.93
Certificates: 0.00
Loans: 0.00
Money Management: 306,432.43
Page:
1 of
2
Get your cash fast and direct deposit your IRS Tax Refund. See the enclosed
insert for more information.
~
f
i
?
~
~
"
~
10 -IRA SAVINGS
"I
>< if ~,. . .. '". , ',\;;O,;~:~~.",?,; i~\
j\"''')l,, ',i~:'::,; ..i\ ~: '::'"~:::':"'<j.,;: ;:Jt>~i,N,
'Dale c' Tratiilaclion DescnDtion ..L
.Ian 01 8a/srt(:B FotwlurI ..' . '.;; .' . '. '.
Jan 31 OepDstt .Dividend 1.390"10 . .
Annus/ Percsilfa/J9 YJBid J:amed 1.4()(1% from 01/01/2005 through 01/31/2005
.Ian 31 Endir1g Balance
'~~:';;ii
.\"'
I':
~'
r
1
~
,
!
J
i
H
Additions
'Subtractions
Balance
28,234.22
28,267 .55
28,267 .55
.33.33
Vl1!':Tn1
--- Continued on following palle ...
Joan Capehart Estate Series E Bonds Redemption Information 3/24/2005
DATE BOND NUMBER REDEMPTION VALUE
May-62 Q1942206319E $210.24
J un-62 Q1942754613E $210.79
Jul-62 Q1949427753E $210.79 I $(; iNN!)
Sep-62 Q1957682630E $214.32
Oct-62 Q1962178513E $214.33
Dec-62 Q1962178904E $215.22 7Q+llJ.. ..f
Jan-63 Q1974407920E $215.22 1//1/../,/': d.-;). ).09 '7
Feb-63 Q1984805218E $217.31
Apr-63 Q1991377136E $218.29 /I
May-63 Q1997564057E $218.29 /'",:+ . :z, '1 ;25. b
Jul-63 Q1997564440E $219.95
Aug-63 Q2012294684E $222.11 /I
Sep-63 Q2013234260E $223.17 ..,-~- ....
Nov-63 Q2025143387E $223.17 ' if;J.f3,73
J
Dec-63 Q2033278448E $224.55
Jan-64 Q2035728168E $224.55
Mar-64 Q2046186008E $227.79
Apr-64 Q2046188410E $227.77
May-64 Q2055516001E $227.77
J ul-64 Q 1854078929E $229.29
AUQ-64 Q2063335407E $231.52
Oct-64 Q2072895691E $232.61
Nov-64 Q2085571772E $232.61
Dec-64 Q2095145177E $234.11
Feb-65 Q2105874303E $212.62
Mar-65 Q2105874644E $213.66
May-65 Q2105874990E $209.45
Jun-65 Q2117424278E $180.90
Jul-65 Q2117424623E $180.90
Sep-65 Q2130977002E $178.40
Oct-65 Q2130977357E $178.40
Nov-65 Q2153131316E $176.12
Jan-66 Q2153131680E $128.13
Feb-66 Q2163715245E $128.13
Apr-66 Q2163715612E $121.94
Mav-66 Q2179249304E $122.02
Jun-66 Q2192860010E $123.28
AUQ-66 Q2192860420E $123.27
Sep-66 Q2204378749E $123.27
Oct-66 Q2204379187E $123.27
Dec-66 Q2218026944E $125.85
Jan-67 Q2218027387E $125.86
Mar-67 Q2241742018E $125.86
Apr-67 Q2241742485E $125.86
Mav-67 Q2258898540E $127.06
Jul-67 Q2258899001 E $128.45
AUQ-67 Q2276725462E $128.45
Seo-67 Q2276725932E $128.45
Oct-79 06345444549E $89.90
Dec-79 06345444707E $90.75
Jan-80 06345444856E $90.75
Mar-80 06345444972E $88.97
$22,208.73
LAST WILL AND TESTAMENT OF
JOAN E. CAPEHART
I, Joan E. Capehart, of North Middleton Township, Cumberland
County, pennsylvania, declare this to be my last Will and
Testament and revoke all Wills and Codicils previously made by me.
ITEM I: I direct that my just debts and the expenses of the
administration of my estate, including any state, federal or other
death taxes payable because of my death, shall be paid from my
residuary estate as soon as practicable after my decease as a part
of the expense of the administration of my estate.
ITEM II: I bequeath my garnet antique ring to my niece
Cheryl Clippinger Warner, absolutely.
ITEM III:
I bequeath my Victorian white gold antique ring
with three diamonds to my niece, Judith Clippinger L~rgent,
absolutely.
ITEM IV: I devise and bequeath the reside of my estate of
every nature and wherever situate to my husband, Paul E. Capehart,
provided he survives me by thirty (30) days.
ITEM V:
Should my said husband, Paul E. Capehart,
predecease me or die on or before the thirtieth day following my
death, and should our Scottish Terrier dog, MacIver, be living at
the date of my death, I direct that the sum of Five Thousand
($5,000.00) Dollars be set aside by my hereinafter named successor
Executrices to provide for proper care and veterinary treatment of
&~6.
:
I~p
/jr
,
ITEM VII:
I appoint Farmers Trust Company, of Carlisle,
Pennsylvania, guardian of any property which passes either under
this Will or otherwise, to a minor and with respect to which I am
authorized to appoint a guardian and have not otherwise
specifically done so, provided that this appointment of a guardian
shall not supersede the right of any fiduciary in its discretion
to distribute a share where possible to the minor or to another
for the minor's benefit. Such guardian shall have the power to use
principal, as well as income, from time to time, for the minor's
support, medical and health care and education, or to make payment
for these purposes to the minor or to any person taking care of
the minor, without further responsibility.
ITEM VIII: I appoint my said husband, Paul E. Capehart,
Executor of this my last Will. Should my said husband cease to act
or fail to qualify as Executor, I appoint my said nieces, Judith
(Clippinger) Largent and Cheryl (CLippinger) Warner, or the
survivor, Executrices of this my Last Will.
ITEM IX:
I direct that all fiduciaries acting under this
Will, whether or not named herein, shall not be required to give
bond for the faithful performance of their duties in any
jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
:":;-" day of August, 1986.
;~ ,~' /,
Joan-E.
/f fYI.,':. /./;;;1
Capehart
[SEAL]
The preceding instrument, consisting of three (3) other
typewritten pages, each identified by the signature of the
Testatrix, was on the date thereof, signed, published and declared
by Joan E. Capehart the Testatrix herein named, as and for her
last Will, in the presence of us, who, at her request, in her
presence, and in the presence of each other, have subscribed our
names as witnesses hereto.
I{,\--'> /1:J /-;::;/ _ / ,)',"" /
c.' .c;::.f?: I :---'1~, J~4k, .
, /' I,"
,
"
,-"Ii ,jl,Q, t'
<,f'j) I'l, l.<.a '
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
I, Joan E. Capehart, Testatrix, 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 acknowledged before me by Joan E.
Capehart, Testatrix, this 29th day of August, 1986.
/f ~" i(' :/I,'J L"( ;'::', 0;,1:. ~: :{
/L; - '/> IY TEJPtatrix
I-~h,,,,,,,,,,,,,,,,'{--e...-' 1'/\ \."'<:,t--;-;t'"1...e........
BCNN,e l. COYl~L""y Public
"'t holly Spring~;. Cum\:krl\1nd Co.. ;'~,
My Commission Exp;rr;:; (Jet, 6, i'i-',')"
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
We, Dale F. Shughart, Jr. and Mary M. Price, 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 Joan E. Capehart, Testatrix, sign and execute
the instrument as her Last Will; that she signed willingly and
that she executed it as her free and voluntary act for the
purposes therein expressed; that both of us in the hearing and
sight of the Testatrix signed the Will as witnesses; and that to
the best of our knowledge the Testatrix was at that time 18 or
more years of age, of sound mind and under no constraint or undue
influence.
Sworn or affirmed to
Shughart, Jr. and Mary M.
August, 1986.
and subscribed before me by Dale F.
Price, witnesses, this 29th1day of
) a' /"/,,,~) / ):)
~"__"" ... ! i
(J( cZ", A f , ///-"0 I-A, Ii! !
;,' //"' .. /' .,1'Wi tness
, "It ;'!
; I \ /<,<Q, :
/", _, /' "/j" l/ ~Wi tness
/.~ J~"""-v,-""'--<'-.e__ ~ {,~.I'i;~...:--
, """ ?!
:",J
jG;';;~:t L ((-'\LE, N''Jt;,r'/ Pub!'c
~'t . ".. -'. . 1 I
'1' . /;r.:,. ",('fjr," :::'jl~,J.. r h"d Co
\,' ,~,.,... :,C~ ~-"i-"+ , 1 '-
Register of Wills of Cumberland County, Pennsylvania
INVENTORY
Estate of
Capehart, Joan E.
, Deceased
No. 21 - 05 - 0113
Date of Death 1/24/2005
Social Security No. 198-30-] 405
also known as
Paul E. Capehan
The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory
include all of the personal assets wherever siluate and all of the real estate located in the Commonwealth of Pennsylvania
of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the
Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that
which appears in a memorandum at the end of this Inventory. l!We verify that the statements made in this Inventory are true
and correct. l!We understand that false-statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904
retating to unsworn falsification to authorities.
i.D. No.:
19373
Personal Representative
Signature:
Paul E. Capehart ~
Signature: ~ /7/ /'
#~/' a#~ .
Signature: f .
Attorney:
Dale F Shughmt, Jr. Esquire
Address:
35 E. High Street, Suite 203
Address: 927 Gobin Drive
Carlisle, P A 17013
Carlisle, P A 17013
Telephone: 717/241-4311
Telephone: 717-243-6949
Dated:
Personal Property
(_f
Ladies engagement ring, .04 karat diamond, 14 karat gold mount, specifically bequeathed to
Judith Clippinger Largent, value based upon attached appraisal of Henry Line.
424.00
Ladies garnet and .04 karat diamond ling, on 15 kaJ'at gold mounting, value based upon
attached appraisal of Herny Line.
408.00
Miscellaneous personal effects and jewehy not specifically bequeathed.
2,500.00
Eight $25.00 U.S. Series E Savings Bonds issued to Joan E. Peterson (now Capehart). Pay on
death to Mr. George I. Peterson, Father of Joan (Peterson) Capehart who died on July 30,
1973. Value based upon attached itemization.
1,517.11
Total Personal Property
$4,849.11
(Attach additional sheets if necessary)
Total Personal Property and Real Estate
$4,849.11
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
SHUGHART DALE F JR
35 EAST HIGH STREET
SUITE 203
CARLISLE, PA 17013
__uuu told
ESTATE INFORMATION: SSN: 198-30-1405
FILE NUMBER: 2105-0113
DECEDENT NAME: CAPEHART JOAN E
DATE OF PAYMENT: 04/15/2005
POSTMARK DATE: 04/15/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 01/24/2005
NO. CD 005203
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $118.56
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 3069
SEAL
INITIALS: JA
RECEIVED BY:
$118.56
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
T,U~P::,,[R
kc::", 0+ (>.J. \ \s