HomeMy WebLinkAbout02-0921
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of Bernard W. Shaffer
also known as
No.
To:
d-./ -();). -q.:l I
Deceased.
Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsylvania
Social Security No.
164-36-5594
The petition of the undersigned respectfully represents that:
Your petitioner(x), who is/:amd8 years of age or older, appLies
for letters of administration
on the estate of
(d.b.n.; pendente Iile; durante absentia; durante minoritatc)
the above decedent.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with
"is last family or principal residence at 129 Walnut Bottom Road. Shippensburg, .
(list street, number, Twp. or Boro.) Southampton Township
Decedent, then 56 years of age, died February 11 ,~ 2002
at Chambersburg Hospital, Chambersburg, PA
Decedent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows: None
$ 1,926.00
$
$
$
Petitioner_ after a proper search ha...1L- ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name Relationship Residence
Chad Shaffer Son Unknown
Wendv "haffer Dau"hter Blue Ridue Summit PA
Vir"inia E. Forbe~ ~aster "hambersburu. PA
Dennis L. Shaffer Brother Orrstown, PA
Karen S. Hissou" Sister Orrstown, PA
Cynthia J. Huss Sister Chambersburg, PA
Nancy K. Gabler Sister Chambersbur". PA
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration 'in the
appropriate form to the undersigned.
'"
_
u
e
-a-
.- ~
~-
_ -
'"'-
=
-g.g
<<I";::
-;;-~
'U"~
~o
:;
=
"
v;
~~t:.~~
Vi inia E. Forbes
565 Stouffer Ayenue
Chambersburg, PA 17201
(717) 267-3988
/7-91/- 'I
______ __ .. _.......,.".l,ra.&.I .~.. .~~" ..~.......
COMMONWEALm OF PENNSYLVANIA
COUNTY OF CUMBERLAND
} 58
~.,,~,. r..
::.-".
d
~.
The petitioner(s) above-named swear(s) or affirm(s) tbat the
statements in tbe foregoing petition are true and correct to tbe best
of the knowledge and belief of petitioner(s) and tbat as personal
representative(s) of the above decedent petitioner(s) will well and '-J
-_-.""-:-~,.. ~j:,#,1 ((MV))
~nja E. orbes
I
\.0
B
-;;-
J
t;
.~
'"
No. 21-2002-921
Estate of
Bernard W. Shaffer
,Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW October 11 th ~ 200f in consideration of the petition on
tbe reverse side bereof, satisfactory proof baving been presented before me,
IT IS DECREED tbat Virginia E. Forbes
is/are entitled to Letters of Administration, and in accord witb such finding, Letters of Administration
Virginia E. Forbes
Bernard W. .Shaffer----
are bereby granted to
in tbe estate of
Donna M.
FEES
Letters of Administration .....
Short Certificates(3) . . . . . . . . . .
R .. 5
enunciation ................
JCP
S 25.00
S 9.00
S 25.00
S 5.00
TOTAL $ 70.00
.9'?~.~~. p~~!.~9gfA.D. ~
Jerry A. Wei~le. r."qllire 1101"74
AlTORNEY (Sup. Q. J.D. No.)
WEIGLE & ASSOCIATES, P.C.
ADDRESS
126 East King Street
Sbippensburg. PA 172~7
PHONE
(717) 532-7388
Filed
Call first, then put in Prothonotary 10/11/02
HI05.1105 REV' ')/ll(,
This is to certifY that the infotmation here given is correctly copied from an otiginal certificare of death duly filed with me as
Local Registrar. The otiginal certificate will be forwarded to the State Vital Records OfHce for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
P 8167812
No.
\,~I.~~\.,rotp11-.-#~
""~"''.fIn'-
l~ ,'c', ..::_ ' u~\.
,~-,-"<:<:,,
~~, '-''J''!t."''':, ". \?'i
~ ~i :~ -. ' '.:Z~
~ ~1' -;%:: :Ii;;~
\*'~. ..'.... ~V*j
\* ':'.>.'' ~~i
"'::.~ - ~~l
'--)?''''ENT ~\ ~ ""o'!
........",,'''#;#111111111..
Fee for this certificate, $2.00
yAj-? 2.t'JC'Z--
Date
lR.,2IIT
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. YITAL RECORDS
CEFlTIFICATE OF DEATH
1. Bernard
,oQEl1AII~
W. Shaffer
......,......
- -
-
"'-
i-
..
',_,0.>1,_\
~'Ma :J~.;::"=":.~~ ,,;:J;":;e::.:v~~' ?002 ]
IC"I'_ ~ IC'-'o",..,."..___......._
_..f""'9'~ HOSPITN.: taft -
hambersbu-r ,PA........l)l ~O w.O :"0 ___.0 ~O
1oIMI((II....._....___, I'W:E -.c.tl__-'__
.-., .
"-"<<OI'oEcr:QENTlf",.Mi<lI:M"..,
56 ~
""'""
10/10/1945
"".
129 Walnut Bottom
1&. Shippensburg. PA
_"'S_(F"."'_lMll
I James v. Shaffer
IJII'Ol'lIoWf1"MMI(T~
Vir inia E. Forbes
Road
17257
. t
~.
""'"'
--
-
--
,.
White
""""""''''''''''
,"-,-- -
Franklin
DENI'SUSUAL
l~-=::.=.,,=.::::=r
- 11 Laborer , US Gov r
Q1E1XOf.NT"SMM.lNOAODIII!.(Slo...~.s.o..ZlpCo<lltl
Chambersb1.;it
.... .....
.~....-
---
--
,,.,
Cu:inbl!rl and.
..
--
-..
--- 1,.rJ ~~~..
'"_4'....._.....,......
..
17a.(t..................
Southampton
-
17a.-
.....,
.
-
.ll!>CclOoI
~
._-
.-.
_.llpCodio
.... -
.
y
2002
-
.,.park
9/,n.
... ....0
~,o.w_.
I 0
o
o
I"",^"',ea,._)
-"'"
0," ....-
..0
M
.,g
N, .
1'._" I....,...._.-""...~.___."._ DO....._"""_oI<1ylt1g,....~..o..llIooeer'.IIfI"."''''."......._'''__
ll......__...__
_M__
.--....-
__uteIlIU1MI
-<<-"'~
---
..........-..LAIT
I:
~,.,{>~
DUE10 A!IACON!IEOUEHCECIl'r.
~....."L\.~lr-
DUElOlOIIASAGONSEOlIENaOFt
:==~-
:"""""--
i
It\ 0............_................_."'"
..._......~~_.."""t.
_ICAUM(F_
-.-
,-...---
DUl!!1OlOfl~"CONSECMJf"lCE0Fr
--....... .................... "'~.
~- --..-'"
"'''''''' - ~
""""
-
..0 ..~ ..0 ..0 ..... 0
1lIlTl'0f'1NJ01lT
_00v,_1
111llE0f'....UAY
Y.~ OESCRIMI1OWIH.NIIYlXl;;~D
-
--
o
o
o Pl.AGE(J#fiJUflY.Al_._.-.lKIDry._ III
...-.,.....S9tocM
_.
_ 0_0
-"'"
CouIdIlll."""""'"
".--
-
CIJIIT.....'O-__
'~lI1fYWlClAfll~~_d__._~__pr~__",""IOOMlI"""'~JI
,-.._.,,,,,~.-...,.,......._....-.....:~-_..-.....
...
-M/OCUlTJFYitrlo~I~_"''''''''''-':01O__-.oIyot>o'''''''''CJ!_1
.,...._.,""..............,_"'........'"""ac""'_._._plaH.__........-.(~.....___,.
Ill,""""
o
.......
\~27'lTWoiIOI
SlGNEDc_, Oa>-,_l
uS'\ ./- z.. I\' O~
WHO~OCAUSEOf'llE,(n.
~. ...e,.......... _
""" "'O.UW'l\) ,,"""
It
~
. h{/ 4,.:J~
..-ow;JIL1XA....1l:/COfIIOHE..
On_,.....,.._...ton....uor_.......,In""'op........,....Ollcunwd..lhf_,.....,_pr.c.,_~to_c...-.(.I~
-..-..
...
~1$T$UR'S~oMD~J\_
o
N.
o.ol"EFII.
"
N.
AFFIDAVIT OF EFFORTS TO LOCATE MISSING HEIR BY APPLICANT FOR 21-2002-92
LETTERS OF ADMINISTRATION IN THE ESTATE OF BERNARD W. SHAFFER,
DECEASED
I, Virginia E. Forbes, presently of 565 Stouffer Avenue, Chambersburg,
Franklin County, Pennsylvania, being duly sworn according to law, depose and state as
follows:
1. I am the sole applicant for Letters of Administration in the estate of Bernard W.
Shaffer, who passed away intestate and a resident of Cumberland County,
Pennsylvania, on February 11,2002.
2. The decedent died a single person leaving the following children and siblings:
a. Chad Shaffer (son, age 26) - address and whereabouts unknown.
b. Wendy Shaffer (daughter, age 31), presently of 13622 Summit Avenue,
Blue Ridge Summit, PA, 17214.
c. Virginia E. Forbes (sister), presently of 565 Stouffer Avenue,
Chambersburg, PA, 17201.
d. Dennis L. Shaffer (brother), presently of 10092 Blue Jay Circle,
Orrstown, P A, 17244.
e. Karen S. Hissong (sister), presently of 10242 Cardinal Drive, Orrstown,
PA,I7244.
f. Cynthia 1. Huss (sister), presently of 185 Echo Drive, Chambersburg,
PA,I7201.
g. Nancy K. Gabler (sister), presently of 153 Carbaugh Drive,
Chambersburg, P A, 17201.
3. All of the above referenced individuals whose whereabouts are known have
been contacted and wish to renounce his/her right to participate in the settlement
of the above referenced estate as a personal representative and are willing to
renounce said right in writing in favor of the said Virginia E. Forbes.
4. The whereabouts of the above referenced Chad Shaffer, son of the decedent, are
unknown, with no one in the family having had contact with him for a period in
excess of twenty-five (25) years.
5. The affiant, Virginia E. Forbes, has made the following efforts to locate the
precise whereabouts of the aforementioned Chad Shaffer, but without success:
a. Personally contacted State Representative Jeff Coy's Office, who
furnished her with a list of seven (7) Chad Shaffers obtained from the
internet living within the Commonwealth of Pennsylvania - all leads
were followed, but without success.
WEIGLE & ASSOCIATES, Re. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397
b. Personally contacted post offices in State Line, Pennsylvania, and
Greencastle, Pennsylvania, where Chad Shaffer was believed to reside at
one time, who suggested sending letters addressed to Chad Shaffer with
the affiant's name and return address noted thereon. Said
correspondence was subsequently returned by both post offices as
undeliverable.
c. Personal contacts to sister, uncle, and aunts of Chad Shaffer who had no
information on his present whereabouts and who indicated no personal
contact for a period in excess of twenty-five years.
6. The estate of Bernard W. Shaffer is expected to be insolvent.
7. The purpose of applying for Letters of Administration in the estate of Bernard
W. Shaffer is to obtain Short Certificates needed to settle the estate as follows:
a. To sell a 1984 Chevrolet Celebrity Station Wagon valued at $200.00
b. To apply for a 2001 federal income tax refund of $726.00.
c. To apply for a benefit from Goodwill Fire Company of$I,OOO.OO.
SWORN TO AND SUBSCRIBED
before me this 'Z-fD ~ day of
September, 2002.
cI~ )( ~
Notary Public
Notanal Seal
Unda K, Klein, Notary Public
Shlppensburg, PA Cumoe'l1ane County
My Commission Expires August 15, 2004
~J ,f-ffiA);4/
Vir ia E. Forbes
A lant
WEIGLE & ASSOCIATES, RC. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397
RENUNCIATION
21-2002-921
In Re Estate of
Bernard W. Shaffer
deceased.
To the Register of Wills of
Cumberland
County, Pennsylvania.
The undersigned
Nancy K. Gabler, sister
of
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
of Administration
be issued to
Virginia E. Forbes
WITNESS
my
/00
hand this _ tJ
day of ...I ~
,JOO~.
H Jb1{~si!~Ah;J
Nancy K. Gabler
153 Carbaugh Drive
Chambersburg, PA 17201
(Address)
(Signature)
(Address)
(Signature)
i)-
,?Ct
(Address)
RENUNCIATION
RECEWEO OC1 - 1 -
21-2002-921
In Re Estate of
Bernard W. Shaffer
deceased.
To the Register of Wills of
Cumberland
County, Pennsylvania.
The undersigned
Wendy Shaffer, daughter
of
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
of Administration
be issued to
Virginia E. Forbes
WITNESS
my
hand this {11-!:b daYOf'~ phi't\be ( ,lOO..20.Q2....
IUncIJ0ho{ffiD
..,./ (Signa~
Wendy Shaffer
13622 Summit Avenue
Blue Ridge Summit, FA 17214
(Address)
(Signature)
(Address)
(Signature)
f)'-
!,. -',
. iJ.
(Address)
RENUNCIATION
21-2002-921
In Re Estate of
Bernard W. Shaffer
deceased.
To the Register of Wills of
Cumberland
County, Pennsylvania.
The undersigned
Dennis L. Shaffer, brother
of
the above decedent, hereby renounee(s) the right to administer the estate and respectfully ask(s) that Letters
of Administration
be issued to
Virginia E. Forbes
WITNESS
my
hand this 'if ~ day of 6hS~ ,xJi9..2ill!2..-.
/ d~~14
Dennis L. Shaffer
10092 Blue Jay Circle
Orrstown, PA 17244
(Address)
(Signature)
(Address)
(Signature)
1'\
'.'
u-
if ,'-,
!
(Address)
RENUNCIATION
21-2002-921
In Re Estate of
Bernard W. Shaffer
deceased.
To the Register of Wills of
Cumberland
County, Pennsylvania.
The undersigned
Karen S. Hissong, sister
of
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
of Administration
be issued to
Virginia E. Forbes
WITNESS
my
hand this I q
day of a ~ LLIJ t ,lOO2.0..02....
/ ~11 f1( i. I~ J)f,(rX 0/-
(Signature) ()
Karen S. Hissong
10242 Cardinal Drive
Orrstown, PA 17244
(Address)
(Signature)
(Address)
(Signature)
1/".
,-J-
(Address)
RENUNCIATION
21-2002-921
In Re Estate of
Bernard W. Shaffer
deceased.
To the Register of Wills of
Cumberland
County, Pennsylvania.
The undersigned
Cynthia J. Huss, sister
of
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
of Administration
be issued to
Virginia E. Forbes
WITNESS
my
C!-
hand this fCf day of ~,xJi9..2Qil.Z....
c/
Cynthia J. Huss
185 Echo Drive
Chambersburg, PA
17201
(Address)
(Signature)
(Address)
(Signature)
.'.,1
(1-- I r: i
(Address)
INRE:
ESTATE OF BERNARD W.
SHAFFER, late of the Township of
Southampton, Cumberland County,
Pennsylvania, deceased
: IN THE COURT OF COMMON PLEAS OF
: CUMBERLAND COUNTY
: PENNSYLVANIA
ORPHANS' COURT DNISION
: ESTATENUMBER21-02-0921
CERTIFICATION OF NOTICE UNDER RULE 5.6 (a)
Name of Decedent: Bernard W. Shaffer
Date of Death: February 11,2002
Will No. 21-02-0921
To the Register:
I certifY that notice of beneficial interest required by RuIe 5.6(a) of the Orphans'
Court Rules was served on or mailed to the following beneficiary of the above-
captioned estate on October 22, 2002:
Wendy Shaffer
13622 Summit Avenue
Blue Ridge Summit, P A 17214
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
NONE.
October 22, 2002
0, c cJc
Name:
Jerry A. eigle, Esquire
Address:
Weigle & Associates, P.C.
126 East King Street
Shippensburg, P A 17257
.~
Telephone: (717) 532-7388
Capacity: Personal Representative
X Counsel for Personal
Representative
WEIGLE & ASSOCIATES, p.c. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPARTMENT 280601
HARRISBURG, PA 17128-0601
Telephone
717 787-3930
October 28,2002
Dear Register of Wills:
Re: Estate of Bernard Shaffer
File Number: 2802-0206
County: Franklin
Date of Death: February 11,2002
The subject decedent legally resided in Cumberland County as of the date of death.
Accordingly, you are authorized to cancel file number 2802-0206. All matters concerning this
estate should be maintained under Cumberland County File Number 2102-0921.
All original Inheritance Tax documents for the subject decedent should be forwarded to
the Cumberland County Register of Wills; however, you may wish to retain a copy, including
photocopies of all receipts for the collection of Inheritance Taxes in the subject estate which
have been issued by your office.
Please contact me at the telephone number above if you have any questions.
Sincerely,
.' . <. .../j;'., _ /l~""j; //i;')' i'C(./li~i)"
~/~l;'J"j'-i';;'-.'- ~'.r.~J() v[}!//0 '~.>-
/ Mffr~ Hollenbush, Supervisor
Document Processing Unit
Inheritance Tax Division
R~.V-1500 EX (8-00] .
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
;7 - CfL/- Cf
REV-1500
~
~5'(f.I
u"''''
w"-u
:r~g
u..1ll
~
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I-
Z
W
o
W
o
W
o
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Shaffer, Bernard W.
t/
OFFICIAL USE ONLY
FILE NUMBER
1--1--02
COUNTY CODE YEAR
~~LL_
NUMBER
DATE DF DEATH (MM-DD-YEAR)
02/11/2002
DATE OF BIRTH (MM-DD-YEAR)
10/10/1945
SOCIAL SECURITY NUMBER
164
- 36
- 5594
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (lAST, FIRST, AND MIDDLE INITIAL)
[J9 1. Original Return
o 4. Limited Estate
06. Decedent Died Testate (Altachoo~yolWm\
o 9. Litigation Proceeds Received
o 2. Supplemental Return
D 4a. Future Interest Compromise (date ofdealh after 12-12-82)
o 7. Decedent Maintained a living Trust (Attach copy olTl1.Ist)
o 10. Spousal Poverty Credit (dale of death between 12-31-91 and 1.1-95)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Return (date of death ~rior to 12-13-82)
D 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (AltactlSct\0\
z
o
~
I-
::l
D.
:E
o
o
~
!;;
w
c
z
o
"-
.,
~
o
u
Jerry A. Weigle, Esquire
FIRM NAME t~ Applicable)
COMPLETE MAILING ADDRESS
126 East King Street
Shippensburg, PA 17257
NAME
Weigle & Associates, P.C.
TELEPHONE NUMBER
(717) 532-7388
OFFICIAL USE ONLY
(8)
1,982.19
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1)
(2)
(3)
(4)
(5)
1.982.19
(11)
(12)
(13)
10,053.69
(8,071.50)
z
o
~
::l
I-
0::
<C
o
w
0::
3. Closely Hekl 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
(Schedule G or l)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Admin)strative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens {Schedule I)
11. Total Deductions (total Lines 9 & 1O)
(9)
(10)
8,492.50
1,561.19
(14)
NONE - INSOLVENT
(6)
(7)
12. Net Value of Estate (Une 8.minus Line 11)
13. Charitable and Governmental Bequests/Sec 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)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount 01 line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
, .0 (15)
(19)
NONE - INSOLVENT
16. Amount of Line 14 taxable at lineal rate
'.0_ (16)
, .12 (17)
'.15 (18)
17. Amount of line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Decedent's Complete Address:
STREET ADDRESS 129 Walnut Bottom Road
CITY Shippensburg I STATE I ZIP 17257
PA
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1)
2. Credils/Paymenls
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Tolal Credils (A' B . C ) (2)
3. InteresVPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty ( D . E ) (3)
4. If Line 2 is greater than Line 1 . Line 3, enler 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. (5B) NONE - INSOLVENT
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
a. relain the use or income of the property lransferred;.......................................................................................... 0
b. retain the right to designate who shail use the property transferred Or its income; ............................................ 0
d. retain a reversionary interest; or...... ....... ........................ ......... ..... ............................ ....... ...............................m.. 0
d. receive the promise for life of either payments, benefits or care? ..."..........,..."................................................. 0
2. If death occurred after December 12, 1982, did decedent transfer property within one yeer of death
without receiving adequate consideration? .............................................................................................................. 0
3. Did decedent own an "in trust for" or payabie upon death bank accounl or secuilly al his or her death? .............. 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? . ...... .............. ..... .............. ..... ....................... .................................... ............,... .... 0
No
[[]
[[]
[[]
[[]
iU
[]
[[]
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 of perjury, I declare that I have examined this return. including accompanying schedules and statements, and to the best ormy knowledge and belief, it is true, correct
and complete.
Declaration of preparer other tilan the personal representati'le is based on all inlorma\ion of which preparer has any knowledge.
SIGN FO G R URN
Virginia E. Forbes
17201
~-o
ADDRESS
Weigle & Associates, P.C., 1
East Kin Street, Shi
PA
17257
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 P.S. ~9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, Ihe tax rate imposed on Ihe nel vaiue 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 exemDt 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.S. ~9116(a)(1.2)J.
The tax rate imposed on the net vaiue of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(I)].
The tax rate imposed on the net vaiue ot lrans!ers to or for the use of the decedent's siblings is 12% [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.
,
R~V_1508 EX+ (2.B7)
,.
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Please Print or Type
FILE NUMBER
COMMONWEALTH OF PENNSYLVANIA
INHERITANCI: TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Bernard W. Shaffer
21-02-0921
{All propel"ty ioi.ntly-owned with the Right of Survivorship must be disclosed on Schedule Fl
ITEM
NUMBER
DESCRIPTION
VALUE AT
DATE OF DEATH
1.
1984 Chevrolet Celebrity - proceeds of sale
200.00
2.
U.S. Treasury - 2001 federal income tax refund
760.19
3.
Leader Insurance Company - auto premium refund
22.00
4.
Chambersburg Fireman's Relief Association - death benefit
1,000.00
.
TOTAL (Also enter on line 5, Recapitulation) S
1,982.19
(Attach oddilional 8V2" X 11"- sheets)f more space is needed.)
REV. \5 \I 1')( + {7 .6B~
ESTATE OF
ITEM
NUMBER
A.
1.
B.
2.
'*
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
Please Print or Type
FILE NUMBER
21-02-0921
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Bernard W. Shaffer
DESCRIPTION
Funerol Expenses:
Thomas L. Giesel Funeral Rome
Parklawns Memorial Gardens - interment and memorial
Administrative Costs:
1.
Personal Representative Commissions
Social Security Number of Personal Representative:
Year Commissions paid
Attorney Fees Weigle & Associates, P.C.
3. Family Exemption
Claimant
Address of Claimant at decedenes death
4.
C.
1.
2.
3.
4.
5.
6.
7.
8.
Relationship
Street Address
City
State
Zip Code
Probate Fees Register of Wills, Cumberland County - Letters of
Administration and Short Certificates
Miscellaneous Expenses:
Register of Wills, Cumberland County - filing PA Insolvent
Inheritance Tax Return
TOTAL (Also enter on line 9, Recapitulatianj
s
(If more 'pace is needed, insert additional sheets of some size.)
AMOUNT
7,073 .00
920.00
412.50
77 .00
10.00
8,492.50
REV.15\2 E~11\-q3l
'*'
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES AND LIENS
Pleose Print or Type
FILE NUMBER
COMMONWEAlTH Of PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEOENT
ESTATE OF
Bernard W. Shaffer
21-02-0921
ITEM
NUMBER
DESCRIPTION
AMOUNT
1.
Outlooke Pointe Nursing Home
1,454.89
2.
Chambersburg Hospital
106.30
TOTAL IAlso enter on line 10, Recapitulationl
$
1,561.19
(If more space is needed, inserl additional sheets of same size.)
~ .
REV-1513EX+(2.a7)
~.~
~
COMMONW~Al!H Of P~NNSYlYANIA
INH~RITANCE (AX RETURN
RESIDENT DEC'~NT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
Bernard W. Shaffer
21-02-0921
ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR
NUMBER SHARE OF ESTATE
A. Taxable Bequests:
1. Not relevant as estate is insolvent.
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
AMOUNT OR
SHARE OF ESTATE
B. Charitable and Governmental Bequests:
1.
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also .ot., 00 Hoe 13. Recapitulation) S
(If more space is needed, insert additional sheets of same size)
/'7- 9~- Y
~ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. ZB06Gl
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
JERRY A WEIGLE ESQ
WEIGLE & ASSOCS
126 EKING ST
SHIPPENSBURG PA 17251'
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
:COUNTY
ACN
03-31-2003
SHAFFER
02-11-2002
21 02-0921
CUMBERLAND
101
AlIOunt Re.itted
*'
IE'f-150n..FP 11l-D31
BERNARD
W
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE .. RETAIN LOWER PORTION FOR YOUR RECORDS .....
REV=i5'4iTCAf'P-fiiFoiriiiiYicE--OF-YNHERiTAiici-TAX-APPRAiiiE'jojEii:r,--ALrOWAiice-ii'R-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SHAFFER BERNARD W FILE NO. 21 02-0921 ACN 101 DATE 03-31-2003
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
r~lect ~igures that include the total ~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Mount oi Line 14 at Spousal rat. US)
16. A.aunt of Line 14 taxable at lineal/Class A rat. (16)
17. Aeaunt of Line 14 et Sibling rete 117l
18. Anount of Line 14 taxable at Collateral/Class Brat. (18)
19. Principal Tax Due
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Re.l Estate (Schedule A)
2. Stocks and Bonds (~l. B)
3. Closely Held stock/Partnership Interest (Schedule C)
4. Hortgages/Notes Receivable (Schedule DJ
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(ll
(2)
(3)
(4)
(S)
(6)
(7l
.00
.00
.00
.00
1.982.19
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Ada. Costs/Misc. Expenses (Schedule H)
10. Debts/Hortgage Liebilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/GovernMental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net V.Iua of Est.te Subject to Tax
(9)
110)
8,492.50
1.561.19
(11)
112)
113)
114)
NOTE:
.00 X
.00 X
.00 X
.00 X
NOTE: To insure proper
credit to your account,
s~it the upper portion
of this form with your
tax pay.ant.
1,982.19
In.nli~ 69
8,071.50-
.00
8,071.50-
00 =
045 =
12 =
15 =
.00
.00
.00
.00
.00
119)=
.AY CR~nIT".
'+J AHDUNT PAID
DATE NUHBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A nCREoI~' ICR), YOU HAY BE DUE
A REFUND. SEE REVERSE SID~ OF THT~ ~nDM rnD T~~?B'_.~_~_ -
STATUS REPORT UNDER RULE 6.12
l{K
REGISTER OF WILLS. CUKBElU.AND COUNTY
Name of Decedent: Bernard W. Shaffer
Date of Death: 02/11/2002
Will No.: Admin. No.: 21-02-0921
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
following with respect to completion of the anrninistration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes Iil No 0 Insolvent PA Inheritance Tax Return was filed and approved.
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 !:XI
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 Iil No 0
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed with the Clerk of the. Orphans' Court
and may be attached to this report.
Date: -.91103/04 ~ (\ .W~
Signature T
Jerry A. Weigle, Esquire
Name
Weigle & Associates, P.C.
126 East King Street
Shippensburg, PA 17257
Address
. -1.
717-532-7388
Telephone No.
Capacity: 0 Personal Representative
!:XI Counsel for personal representative