HomeMy WebLinkAbout05-15-15 • t
J 1505614134
EX(03-14)(FI)
REV���OO OFFICIAL USE ONLY
Bureau of Individual Taxes INHERITANCE TAX RETURN CountyCode Year File Number
PO BOX 280601 f� ���
Harrisbur9,PA 17128-0601 RESIDENT DECEDENI' 2 1 ,
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDWW
0 8 1 7 2 � 1, 4 � 8 2 3 1 9 3 4
DecedenYs Last Name Suffix DecedenYs First Name MI
S H E A F F E R R 0 N A L D W
(If Appiicable)Enter Surviving Spouse's information Below
Spouse's Last Name Suffix Spouse's First Name MI
S H E A F F E R R 0 S E A L M A B
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW •
� 1.Original Return • � 2.Supplemental Return � 3.Remainder Return(date of death
Prior to 12-13-82)
� 4.Agriculture Exemption � 5. Future Interest Compromise(date of � 6.Federal Estate Tax Return Required
(date of death on or after 7-1-2012) death after 12-12-82)
❑X 7. Decedent Died Testate � 8. Decedent Maintained a Living Trust � 9.Total Number of Safe Deposit Boxes
(Attach copy of wiil.) (Attach copy of trust)
� 10.Litigation Proceeds Received � 11.Non-Probate Transferee Return � 12.Deferral/Election of Spousal Trusts
(Schedule F and G Assets only)
❑ 13. Business Assets ❑X 14.Spouse is Sole Beneficiary
(No trust involved)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
H 0 W A R D B • K R U G , E S Q U I R E 7 1, 7 2 3 4 4 1 7 8
First Line of Address
P U R C E L L , K R U G & H A L L E R
Second Line of Address
1 7 1 9 N 0 R T H F R 0 N T S T R E E T
City or Post Office State ZIP Code
H A R R I S B U R G P A 1 7 1 0 2
CorrespondenYs e-mail address: hkfUq@pkh.Com
REGISTER OF WILLS USE ONLY
REGISTER OF WILLS USE ONLY
DATE FILED MMDDYYYY '�-`-'�
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I I�IIII IIIII IIIII IIII)IIIII�II'I IIIII III'I IIII'II'll�III IIII
L 1505614134 7,505614134 �
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REV-�f 500 IX(FI) QNceder[Ys Soaat Security Number
o�M��: RONALD W• SHEAFFER 1 7 2 2 6 9 2 2 1 `
RECAi�ITUTATtON
1. Reai Estafe(Sct}edule A) ............ ..... .......................... 1• �
2. stocks ana Bonas(Schedule B} ...................................... 2. •
3. Closely Held Co�ation,Partnership or Sole-Proprietwshp(Schedu�C) ..... 3. '
4. Mortgages and hto6es Receivable(Sdtedufe Q) .......................... 4. '
5. Cash.Bank Deposits and Miscellaneous Personal Propetty(Schedule E�....... 5. � ' � �
6. Joi�tly Owned Property t�hedule F� ❑ Separate Billing Requested....... 6. 5 1 2 S 8 . 9 �,
7. Inter-\fivos Transfers 8�MiscatNaneous N�Probate Property b � 5 7 � . 5 �
(Schedule G) U Separate BiHing Requested ....... 7.
8. Total Gross Assets(totai Lines 1 through 7) ........................... 8. 1 1 4 $ � 6 . 4 3
...__._...
9. Funeral E�enses ar►d Administrative Costs(Schedule H) ......... ......... 9- 1 Z 9 9 6. 5 9
10. Dabts of Decedent,Mortgage Liabitities,and Liens(Schedute t) ............. 10. 3 ❑ 9 2 2 . � 2
11. 7otal peductions(total Lines 9 and i0) ....................... ........ 1 t. �i �C 9 �+ 9 . 4 7,
12. Net Vatue of Estate(Line S minus Line 11} ............................ 12. Z ], 9 1 7 . � 2
13. Charitabla and Governmentat Bequests/Sec 9113 Trusis for which
an election to tax has not been made(Schadute J} ...................... 13. •
14. Net Va{tte Subject to Ta�c{Line 12 minus Line 13) 7 7, 9 � 7 . ❑ 2
..... ..... ?4. .r�
7RX CALCULATION-SEE lMSTRUCTIONS FOR APPIICABLE RATES
15. Amour�i of Line 14 taxabie ,
at the spousal tax rate,or
lra�sfers under Sec.311fi
(a)t�.2)x.000 7 3, 9 ], 7 . 0 2 15. � . D 0
1 S. Amaunt of l.9�14 taxable � . � � �6. 0. 0 �
at lineal rate X•n_
17. Amourtt of Line 44 taxab�e Q � � d .�7 0 . ❑ �]
at stbting rate X.12
18. Amount of Line 1b taxable � . Q ❑ 1�. �' p Q
at caliaterai rate X.15
19. TAX DUE ...................................................
... 19. � • ❑ �
24i. Fill IN Tt{E OVAL IF YOU ARE REQUESTlNG A REFUND�F AN OYERPAY�ItEN'"'f ❑
Utlder Penaftles of Pe�Nry.1 deCiate i have examined this retum�indudtn9�P�9�and sL:lements,and to 1he ba�of mY knowled9e and belie(.
i!is irue.coR antl complete-DeGaradw+af �arer other tlian the persan responsibie for fiting the reiuE�in�is t�a��Q^d o�a�l infarmeUon of whtch preparer has
e� .._._,_,..,
StG T F PERSQN R QR fIY.IPIG R RN .�^� ��p��/� --
/
A DRE S
6216 Elmer Av Harrisbuir;g_� PA 17112 �
SIG URE O PAREit O PERSON RESPONStBIE FOR FIUNG TNE RETURN � ,� r 1
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ADDRE Harrisbu�°� PA 171Q2
1719 North ront Street ..9._..._..,
�'�'�'�l11l��IIl���S��lll#1����������Illt�� side 2 7,5�561423 4 �
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REV-1500 EX (FI) Page 3 File Numl�er
Decedent's Complete Address: 2� o 0
DECEDENT'S NAME
RONALD W. SHEAFFER
STREET ADDRESS
5 EASTWICK COURT
CITY STATE ZIP
CARLISLE PA 17015
Tax Payments and Credits: �
1• Tax Due(Page 2,Line 19) (1) 0.00
2. Credits/Payments
A.Prior Payments
B.Discount
(See instructions.) Total Credits(A+g) (2) 0.00
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) 0.00
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.00
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 ...................................................................... ❑ 0
b. retain the right to designate who shall use the property transferred or its income ::::::::::::::::::::::::::::::: ❑ 0
c. retain a reversionary interest ................................................................ ❑ �
d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ ❑X
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?.................................................................................................. X❑ ❑
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 chiltl 21 years of age or younger at death to or for the use of a natural parent,an
adoptive parent or a step-parent 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 decedenYs 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.
�.., �.,,-�„�,n.�.�.. �
REV-1508 EX+(�8-12)
pennsylvania SCHEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISG.
INHERITANCE TAX RETURN
RESIDENTDECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
RONALD W. SHEAFFER 21 0 0
Include the proceeds of litigation and the date the proceeds were received by the estate.
Ail property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 2006 Dodge Caravan (Good Condition) 0.00
See attached NADA Guide Price Report($3,437) &Alan Levin appraisal ($3,400).
Value$3,418.50 less Date of Death lien $11,709 leave a negative equity of($8,290.50).
TOTAL(Also enter on Line 5,Recapitulation) $ 0.00
If more space is needed,use additional sheets of paper of the same size.
REV-1+509 EX+(Ot-10)
pennsylvania SCHEDULE F
DEPARTMENTOFREVENUE �OINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
RONALD W. SHEAFFER 21 0 0
If an asset was made jointly owned within one year of the decedent's date of death,Bt must be reported on Schedule G.
SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A. ROSEALMA B. SHEAFFER 5 EASTWICK COURT SPOUSE
CARLISLE, PA 17015
g.
C.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENTS VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. Allstate Performance Plus Annuity 102,517.82 50. 51,258.91
#GA0839352
See attached Allstate statement and letter.
TOTAL(Also enter on Line 6,Recapitulation) S 51 258.91
If more space is needed,use additional sheets of paper of th�sa�ne size.
REV-f 510 EX+(08-09)
pennsylvania SCHEDULE G
DEPARTMENTOF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCETAXRETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
RONALD W. SHEAFFER 21 0 0
This schedule must be completed and filed if the answer to any of questions 1 throug h 4 on page three of the REV-1500 is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDETHENAMEOFTHETRANSFEREE,THEIRRELATIONSHIPTODECEDENTAND DATEOFDEATH %OFDECD�S EXCLUSION TAXABLE
NUMBER THEDATEOFTRANSFER.ATfACHACOPYOFTHEDEEDFORREALESTATE. VALUEOFASSET INTEREST (IFAPPLICABL� VALUE
1. Zurich IRA#K111013784 63,577.52 100.00 0.00 63,577.52
See attached receipt.
TOTAL (Also enter on Line 7,Recapitulation) $ 63,577.52
if more space is needed,use additional sheets of paper of the same size.
REV;1511 EX+(08-13)
pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
RONALD W. SHEAFFER 21 0 0
DecedenYs debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Hollinger Funeral Home&Crematory, Inc. 2,961.67
2. Elks-Board of Governors-Wake 1,500.92
B. ADMINISTRATIVE COSTS:
1. Personaf Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
2, AttomeyFees: PURCELL, KRUG & HALLER 4,019.00
3. Family Exemption:(If decedenYs address is not the same as claimanYs,attach explanation.) 3,500.00
C�aimant ROSEALMA B. SHEAFFER
StreetAddress 5 EASTWICK COURT
City CARLISLE State PA ZIP 17015
RelationshipofClaimanttoDecedent SPOUSE
4• Probate Fees:
5 Accountant Fees:
6. Tax Return Preparer Fees:
7. Inheritance Tax Return -filing fee 15.00
TOTAL(Also enter on Line 9,Recapitulation) S 11 996.59
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(12-12)
pennsylvania SCHEDULE I
DEPARTMENTOFREVENUE DEBTS OF DECEDENT�
INHERITANCETAXRETURN MORTGAGE LIABILITIES 8�LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
RONALD W. SHEAFFER 21 0 0
Report debts incurred 6y 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. Members 1st Bank vehicle loan for 2006 Dodge Caravan (See Schedule E) 8,290.50
#99900010000554311
2. Baker's Best Health 39.94
Order#418398540
3. Family Home Health Care 23.96
Invoice#64400
4. Publisher Clearing House 22.45
ID#01445994567
5. Carlisle HMA Physician Management 30.00
Account#1117250
6. Carlisie Regional Medical Center 1,170.00
Account#9583816
7. Chase Visa credit card 6,551.60
#4147202137674477
8. Walmart/Synchrony Bank credit card 801.19
#6032207540Q99942
9. Chase Visa credit card 8,850.65
#4408041026344063
10. Chase Visa credit card 46.28
#4640182093840480
11. M&T Bank Visa credit card 5,096.25
#xxx1535
TOTAL(Also enter an Line 10,RecapitulatioFl) $ 30 922.82
If more space is needed,insert additional sheets of the same size.
REV-15i3 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
RONALD W. SHEAFFER 21 0 0
RE�ATIOIJSHIP 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 outrightspousal distributions and transfers under
Sec.9116(a)(1.2).]
1. Rosealma B. Sheaffer . Spousal
5 Easfinrick Court 100°/o
Carlisle, PA 17015
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.
WILL
I,Ronald W. Sheaffer, of 602 West Pine Street, Mt. Holly Sprinbs, Cumberland County,
Pennsylvania, declare this to be my last will and revoke any will previously made by me.
Item One: I direct that all my debts and cremation expenses sl�all be paid from my residuary
estate as soon as practicable after my decease as a part of the expense of the administration of my
:,Si.aic.
Ttem Two: I give, devise, and bequeath my entire estate to my wife Rosealma B. Sheaffer, if she
survives me by 60 days. In the event that she predeceases me or is not then living on the 61 st day
after my death,then I give, devise, and bequeath my entire estate to my two daughters, Roxanne C.
Klinger, and Rhonda Y. Dang , share and share alike. In the event that Roxanne C. Klinger
predeceases me, I give,devise, and bequeath her share to be divided equally to Joseph C. Klinger,
son of my daughter Roxanne C. Klinger and Shawn Kiinger, stepson of Roxanne C. Klinger.
Item Three: I appoint my wife Rosealma B. Sheaffer,Executrix of this my last will. Should she
fail to qualify or cease to act as Executor, I appoint my daughter,Roxanne C.Klinger, of 6216
Elmer Avenue,Hanisburg, PA 17112,to act as Executrix with the same rights, powers, and duties.
Should she fail to qualify or cease to act as Executrix,I appoint Clarence W. Klinger,of 6216 Elmer
Avenue, Harrisburg, PA to act as Executor with the same rights,powers and duties.
� Item Four: I appoint my daughter,Roxanne C. Klinger, Guardiai�/Trustee of any property which
� passes to any person under the age of 22 years and with respect to wliicr I am authorized to appoint
a Guardian/Trustee and have not otherwise specifically done so. Should she fail or cease to act as
:� Guardian/Trustee, I appoint Clarence W. Klinger to equally, share and share alike, per stiipes.
,f� Iiem i nree: I appoint my wife, icosealtria s. Slieaiier,�aecutri.� oi«�is r�y last wil?. ��o�ald she
�� fail to qualify or cease to act as Executrix, I appoint my daughter, Roxarme C. Klinger, of 6216
Eliner Avenue, Harrisburg, PA, 17112,to act as Executrix with tlie same rights,powers, and duties.
� Should she fail to qualify or cease to act as Executrix, I appoint Clarence W. Klinger,of 62]6 El,ner
Avenue, Harrisburg, PA to act as Executor with the same rights, powers �id duties.
Item Four: I appoint my daughter,Roxanne C. Klinger, Guardiai�/Trustee of any property which
passes to any person under the age of 22 years and with respect to which I am authorized to appoint
a Guardian/Trustee and have not othenvise specifically done so. Shauld she fail or cease to act as
Guardian/Trustee,I appoint I appoint Clarence W.Klinger,to act witl2 the same rights,powers, and
duties. Guardian shall establish separate guardianship accoi.ults ai�d sha.11 have the power to use
income from time to time for the beneficiary's education, includin�technical and vocational
training and graduate school, travel, support, and welfare without regard to his or her parents'
ability to provide for such education, travel, support, and welfare; or to make payment for these
purposes,without further responsibility, to the beneficiary or to the beneficiary's parents or to any
person taking care of the beneficiary. Guardian shall administer the account until the beneficiary
becomes 18 years of age, at which time the Guardian shall transfer tl�e principal and income
remaining in the separate guardianship account to my Trustee,beiz�g the same person as my
designated Guardian,who shall then administer a trust account, of both principal and income and
any other funds transferred to the accounts designated, for the beneficiary's education, including
- technical and vocational training and graduate school,travel, support;health, and welfare. When
the guardianship or trust account is less than$10,000.00 or the beneficiaiy of the separate trust
becomes 22 years of age,the share of the beneficiary reinaining in the accowzt shall be paid to the
beneficiary in full and the�ardianship or trust terminated. In the event of the death of any
beneficiary after my decease and prior to reaching the age of 2Z years,l�is or her share shall be
distributed equally, share and share alike, among his or her children; otherwise to my surviving
children or child, per stirpes, equally, share and share alike,to be administered in accordance with
the guardianship andlor trust provisions. �uardian and Trustee shall not be required to file
accountings with any court. In the event that any provision of this will shall be interpreted to
violate the Rule Against Perpetuities,then the remaining provisions of this will shall not be invalid.
Trustee shall adnlinister the trust and dispose of assets so as not to violate the rule,making
distribution as required to a life or lives in being plus 21 years.
Item Eive: All estate, inheritance, succession, and other taxes, imposed or payable by reason of
my death, and interest and penalties thereon,with respect to all property comprising my gross estate
for tax purposes, whether or not such property passes under this�vill, s11a11 be paid out of the
principal of my residuaiy estate, without apportionment or right of reimbursement.
,�� Item Six: I direct that my persoizal representative or guardia��shall not be required to give bond
for the faithful perfonnance of their duties in any jurisdiction.
�� m Seven: In addition to the rights and powers given to the fiduciaries by law or elsewhere in
Ite
C� this will, I give to my Executrix during the full time necessary for the administration of my estate
the following rights and powers to be exercised in her sole discretiori.
�� A. To retain any real or personal property which may at any time form a part of my estate so long
� as she deems it advisable.
� B. To invest in any real or personal property without restrictians as to legal investments.
G To repair, alter, improve or lease for any period of time any real or personal properiy and to
give options for leases.
D. To sell at public or private sale, for cash or credit,with or witlzout security, to exchange or to
partition,to mortgage or pledge real or personal property, aild to give options for leases.
E. To make distribution in kind.
F. To coinpromise claims.
IN WITNESS WHER�OF,I have hereunto set my hand this 12t1z day of January, 2006.
- Signed �..�:� ` � �.
Ronald W. Sheaffer
The preceding instrument,consisting of this and two other typewritten pages each identified by the �
signature of the Testator was on the day and date thereof signed,published and declared by the Testator
therein named as and for his last will,in the presence -� s,who at liis reque in his presence and in
the presence of each other have subscribed our names. �
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CVl✓iivY�livl Wl��:t��.�llii'(31N t-'�I�I1V�YI�VA�IIA . � `
: SS
COUNTY OF CUlVIBERLAND . -
We,John H. Broujos and �Ct.l ���j�UC.L n ,witnesses whose names are signed to the attached
or foregoing uistruinent being du y qualified according to law, do depose and say that we were present
and saw the Testator sign and execute the instrument as his last will; that he signed willingly and
executed it as his free and voluntary act for the purposes therein expressed; that each of us in the
hearing and sight of the Testator signed the will as witnesses;and tha� e best of our knowledge,the
Testator was at the time 18 or more years of age, of sound iin and��der no onstraint or undue
influence. �
� ---
; --
`��'._' � L C'�r" - ��`"�'L-->
;
Sworn and subscribed to before � " �
me this 12th day of January,2006. � �J
�, J�� f�EJ3;ftf�t`?NV�JEAi..f�-1 OF'P€NN��LSJ��J(pE
��i-- . . ' ��i.� � Notaoal Seal
� � OTARY PUBLIC I SF�e3�Y Brooks>t�lotary Public
' Carfis9�Boro,C�f�nberland County
t.�,x!;rn�;;'r:n�pir�Aug.5,2009
(illn��a�f��!?�xi�'F...,+'E�.��T o�D,�'1'��@v�:����� _ � ,._.-,�,.. �--��'-------;1._..c�^.�;��n o4l��otaries
v
: S$
COUNTY OF CUMBERLAND .
I,Ronald W. Sheaffer,whose name is signed to the attached document,liaving been duly qualified
according to law, do hereby acknowledge that I signed and executed the instrument as my last will;that
I signed it as my free and voluntary act for the p�'.irposes therein expressed.
��� ��
Ronald W. Sheaffer,Testator
Sworn and affinned to and acknowledged
before me this 12th day of January,2006. C�e���nsiv��r�i c���ErtNsvt,v�N1�
�/!%; �/- � Notarial Seal
� '¢,�� �'�j � Sh�ily Brooks,Notary Public
I�O ARY PUBLIC Carlisle Boro,Cumberiand County
My Commission Ea:pires Aug.5,2009
��!er�ler �e;,.nr;;�(vfinin 4ssociation of Notaries
7
DURABLE POWER OF ATTORI`�E'§�
NOTICE TO PRINCIPAL
�THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE T�-IE PERSON YOU
DESIGNATE(YOUR"AGENT")BROAD POWERS TO HANDLE YOUR PROPERTY,
. WHICH MAY INCLUDE POWERS TO SELL OR OTHERWISE�ISPOSE OF ANY REAL OR
PERSONAL PROPERTY WITHOUT ADVANCE NOTICE TO YOU OR APPROVAL BY YOU.
THIS POWER OF ATTORNEY DOES NOT IMPOSE A DUTY ON YOUR AGENT TO
EXERCISE GRANTED POWERS,BUT WI�EN POWERS ARE EXERCISED, YOUR AGENT
MUST USE DUE CARE TO ACT FOR YOUR BENEFIT AND 1N ACCORDANCE WITH THIS
POWER OF ATTORNEY.
YOUR AGENT MAY EXERCISE THE POWERS GIVEN HERE TIIROUGHOUT YOUR
LIFETIME,EVEN AFTER YOU BECOME 1NCAPACITATED, UNLESS YOU EXPRESSLY
LIMIT THE DURATION OF THESE POWERS OR YOU REVOK�THESE POWERS OR A
COURT ACTING ON YOUR BEHALF TERMINATES YOUR AGENT'S AUTHORITY.
YOUR AGENT MUST KEEP YOUR FUNDS SEPARATE FROM YOUR AGENT'S�UNDS.
A COURT CAN TAKE AWAY THE POWERS OF YOUR AGENT IF IT FINDS YOUR AGENT
IS NOT ACTING PROPERLY.
THE POWERS AND DUTIES OF AN AGENT UNDER A POWER OF ATTORNEY ARE
EXPLAINED MORE FULLY IN 20 PA.C.S. CH. 56.
IF THERE IS ANYTHING ABOUT THIS FORM THAT YOU DO NOT UNDERSTAND,YOU
SHOULD ASK A LAWYER OF YOUR OWN CHOOSING TO EXPLAIN IT TO YOU.
I HAVE READ OR HAD EXPLAII�IED TO ME THIS NOTICE AND I UNDERSTAND ITS
CONTENTS.
DATE: January 5,�2006 �
osealma B. Sheaffer,Princi
KNOW ALL MEN BY THESE PRESENTS,that I,Rosealma B. Sheaffer, of 602 West Pine Street,Mt.
Holly Springs,Cumberland County,Commonwealth of Pennsylvania, appoint my daughter,Roxanne C.
Klinger, as my true and lawful attoiney(hereina$er referred to as my Agent), of 62l 6 Elmer Avenue,
Harrisburg,PA, or in the event she is unable or unwilling to so act, I appoint Clarence W. Klinger,of
6216 Elmer Avenue,Harrisburg,PA, acting jointly or severally, as my agent(s)("my agent")with full
- power of substitution,for me and in my name,to transact all�ny business and to manage all my property
and affairs as I might do if�ersonally present, including but not limited to exercising the following
powers.
My Agent is hereby authorized and empowered,on my behalf
(1) To demand,sue for,receive, collect and hold any and all moneys, securities and other property,
of whatever nature,that I own or is payable to me,both now and in the future;
(2) To deposit or withdraw assets from any account in my name in any bank,securities brokerage
firm or financial institution and, specifically:to sign,endorse or assign any note,check or other
instrument for deposit, discount,collection or whatever;to draw checks upon or otherwise withdraw all
funds in any account of which I am the owner;to offer for redemption,both at or prior to maturity,any
bond, savings certificate, certificate of deposit,or similar instrument, or any obligation of the United
States GoverrLment,and to collect the proceeds froin such redemption;
(3) To gift, sell and convey or lease any asset which I own now or in the future for such price and
upon such terms and conditions as my Agent deems proper and to execute all deeds,assignments,
contracts, stock powers and other instruments necessaiy for such purposes;
(4) To invest in any kind of property,real or personal,as my Agent, in my Agent's sole discretion,
deems appropriate;
(5) To borrow money froin any person or corporation and to pledge or mortgage as security any real
or personal property.
(6) To litigate,submit to arbitration,or settle any claim or dispute arising between�ne and any other
person, corporation or taxing authority;
(7) To prepare, sign and file for me and on iny behalf with any taxing authority any tax returns,
forms and reports that may be required by law;to apply for and receive any refund payable to me by any
ta�ng authority; and to appear for me and in my place at any administrative conference with,or hearing
before, any taxing authority,or at any Tax Court proceedings;
(8) To retain agents,brokers,accountants,attorneys-at-law and other advisors;
(9) To pay any obligations and debts that may now or in the future be owing by me or that are
incurred by my Agent on my behalf;
(10) To have access to any safe deposit box registered in my name and to remove or add to the
contents thereof;
(11) To hold property unregistered or in the name of a nominee;
(12) To disclai�n any interest in property;
(13} To renounce any fiduciary position on my Uehalf;
(14) To authorize any admission to a medicaI,nursing,residential or similar facility and enter into
agreements for my care and to authorize inedical or surgical procedures for me; and
(15) Without limiting the above powers,generally to perform any other acts of any nature as fully
and effectively as I could do if acting personally.
Any person or corporation shall be fully protected in relying upon thi s I'ower of Attorney unless and
until actual notice of its revocation or actual notice of my death is receivec�..
This Power of Attorney constitutes a"Durable Power of Attorney".
This Power of Attorney shall not be affected by and shall survive my disability. No bond shall be
required by my Agent regardless of any legal requirements to the contrary.
AND I HEREB`��iTIFY AT.D CONFIRM any and all acts which my said Agent shall lawfully do or
cause to be done in the premises.
IN WITNESS WHEREOF,I,Rosealma B. Sheaffer,have set my hand and affixed my seal on this Stli .
day of January,2006. �
WIT'NESS
�,�����' �`� ���
=� Rosealma B. Sheaffer �
COMMONWEALTH OF PEI�TNSYLVANIA .
: ss
COUNTY OF CUMBERLAND .
On this,the Sth day of January,2006,before me, a notary public in and for the County of
Cumberland, Commonwealth of Pennsylvania,the undersigned officer,personally appeared
Rosealma B. Sheaffer,known to me(or satisfactorily proven) to be tlle person whose naine is
subscribed to the within instrument, and acknowledged that he executed the same for the purposes
therein contained.
GOMMONW�A�-���F E'ENNSYLVANIA � � /
'�..{..��L l�i'� u�'l'�.'�.
� Notaria't Se�1
She��y a����t�y�'"�'� N` ARY PUBLIC
Carilsie Boro,Cum��24�09
Ny Comm�ssion Expi
Me��r,Pennsylvania Associatlon of Nvtariee
ACKNOWLEDGMENT BY AG�1�1T
I, ROXANNE C. KLINGER,HAVE READ THE ATTACHED POWER OF ATTORNEY AND
AM THE PERSON IDENTIFIED AS THE AGENT FOR THE PRINCIPAL. I HEREBY
ACKNOWLEDGE THAT,IN THE ABSENCE OF A SPECIFIC PROVISION TO THE
CONTRARY IN THE POWER OF ATTORNEY OR 1N 20 PA.C.S.,�WHEN I ACT AS AGENT:
I SHALL EXERCISE THE POWERS FOR THE BENEFIT OF THE PRINCIPAL.
I SHALL KEEP THE ASSETS OF THE PRINCIPAL SEPARATE FROM MY ASSETS.
I SHALL EXERCISE REASONABLE CAUTION AND PRUDENCE.
I SHALL KEEP A FULL AND ACCURATE RECORD OF ALL ACTIONS,RECEIPTS
AND DISBURSEMENTS ON BEHALF OF THE PRINCIPAL.
DATE: January 5,2006
.
Rox nne C. I� inger,Age
COMMONWEALTH OF PENNSYLVANIA .
� : ss
COUNTY OF CUMBERLAND � .
On this,the Sth day of January,2006,before me,a notary public in and for the County of
Cumberland, Conunonwealth of Pennsylvania, the undersigned officer,personally appeared
Roxanne C. Klinger,known to me(or satisfactorily proven)to be the person whose name is
subscribed to the within instrument, and acknowledged that he executed the same far the purposes
therein contained.
'�-��'�����'�:
�
������a�Y�{��pENNSYLVAN�A �O�TARY PUBLIC
�i�t�_�,�:.:al,�u61ic ,
.~;,�n:'`F:�"< _�-•:'•.lt,:joun�
CONiMONW�ALTH OF PENNSYLVANIA
. � ;�':"..�'. : . " :�s (�lotalialSeal
� .. ._:�Vzr;t ,->, . Sheily Brooks,Notary Pub{ic
' Gariisie Boro,Cumberiand County
� Niy Comm'ission F�cpires Aug.5,2009
Member,Pennsylvania Association of Notaries
.-����v�u...0^vrr�r� e
5/�l2015 , 2006 Dak�e Caravan Caravan SE Prices,V�ues&Sp�cs-NADAgtides
NADAguic�es Price Report
� ` Tha Power of Vchisle Information
s;� NAQAguides.com
5/8/2015
2006 Dodge Ca rava n-V6
Caravan SE
Values
Rough Average Clean Clean
Trade-In Trade-In Trade-In Retail
Base Price $1,400 $2,100 $2,675 $4,650
Mileage(38,680) $1,337 $1,337 $1,337 $1,337
Total Base Price $2,737 $3,437 $4,012 $5,987
Options:
Price with Options $2,737 $3,437 $4,012 $5,387
Rough Trade-In-Rough Trade-in values reflect a vehicle in rough condition.Meaning a vehicle with significant mechanical defects requiring repairs in order to
restore reasonable running condition.Paint,body and wheel surfaces have considerable damage to their finish,which may include dull or faded(oxidized)paint,
small to medium size dents,freme damage,rust or obvious signs of previous repairs.Interior refleds above average wear with inoperable equipment,damaged or
missing trim and heavily soiled/permanent imperfections on the headliner,carpet,and upholstery,Vehicle may have a brended title and un-true miteage.Vehicle
will need substantial reconditioning and repair to be made ready for resale.Some existing issues may be di�cult to restore.Because individual vehicie condition
varies greatly,users of NADAguides.com may need to make independent adjustments for actual vehicle condition.
Average Trade-In-The Average Trade-In values on nadaguides.com are meant to reflect a vehicle in average condition.A vehicle that is mechanically sound
but may require some repairs/servicing to pass all necessary inspections;Paint,body and wheel surfaces have moderate imperfections and an average finish and
shine which can be improved with restorative repair;Interior reflects some soiling and wear in relation to vehicle age,with ali equipment operable or requiring
minimal effort to make operable;Clean titie history;Vehicle will need a fair degree of reconditioning to be made ready for resale.Because individual vehicle
condition varies greatly,users of nadaguides.com may need to make independent adjustments for actual�ehicle condition.
Clean Trade-In-Gean Trade-In values reflect a vehicle in clean condition.This means a vehicle with no mechanical defects and passes all necessary inspections
with ease.Paint,body and wheels have minor surface scratching with a high gloss finish and shine.Interior reflects minimal soiling and wear with all equipment in
compiete working order.Vehicle has a ciean title history.Vehicie will need minimal reconditioning to be made ready for resale.Because individual vehicle condition
varies greatly,users of NADAguides.com may need to make independent adjustments for actuai vehicle condition.
Clean Retail-Clean Retail values refled a vehicle in clean condition.This means a vehicle with no mechanical defects and passes all necessary inspections with
ease.Paint,body and wheels have minor surface scratching with a high gloss finish and shine.Interior reflects minimal soiling and wear with all equipment in
complete working order.Vehicle has a clean title history.Because individual vehicle condition varies greatly,users of NADAguides.com may need to make
independent adjustments for actual vehicle condition.Note:Vehicles with low mileage that are in exceptionaliy good condition and/or include a manufacturer
certification can be worth a significantly higher value than the Clean Retail price shown.
OCopyright 2015NADAguides.Ail Rights Rese�ved.NADAguides is an alliance partner of NADA Services Corparation.OCopyright 2015NADASC.Ail Rights Reserved.
http://www.nadaguid�.s.can/Cars/200e"/DodgelCaravan-V6lCaravan-SElValues/Prird 1/2
LAS� -
AZ . �
O. 5600 Al.�EN 10V�1N �OULEVARD � HARRISBU-R�,Pl� 17112 � 652-3600
May 11, 2015 �
To Whom It May Concern:
My name is Alan P. Levin, and I have fifty (50) years experience in the business
of buying and seliing used cars.
On May 1, 2Q15, I inspected a 2006 Dodge Caravan VIN 1 D4GP25E46B645633
with 38,7Q5 mi(es on the odameter. The state inspection sticker had expired at the end
of March 2015. � �
The vehicle is owned by the Estate of Ronald Sheaffer.
Overall, I found the vehicle to be in good condition, and I would pay$3,400 for
the vehicle. -
�i��'�
Alan Levin �
�.�. ��.,,...�,.n.�,�. a
, ' , . � .
� � Alistate.�
You're in gaod hands.
September 23, 2014
Howard B. Krug
Law Offices of Purcell, Krug&Haller
1719 North Front Street
Harrisburg, PA 17102
Re: Ronald W. Sheaffer
Contract No: GA0839352
Dear Mr. Krug:
We received a request to complete IRS Form 712 for the above referenced contract. The purpose of Form
712 is to provide an estate or donor with the value of a life insurance contract or its proceeds as of a certain
date(usually the owne�'s date of death or date of transfer of the contract).
Because this contract is an annuity, it is not reportable on IRS Form 712. I can, however, provide the
following information for estate purposes:
Date of Death: August i7, 2014
Annuity Value as of Date of Death: $ 102,517.82*
Cost Basis: $1 Q0,081.48
Named Beneficiary: Rosealma B.Sheaffer
*The actual amount paid may differ due to Market Value Adjustments and/or any applicable Surrender
Charges.
If you have any questions,please contact us at 1-877-499-6418.
Sincerely,
Steven Arbitman
Senior Claim Examiner
Allstate Life Insurance Company
Life and Annuity Claims
P.O.Box 94212, Palatine, IL 60094-4212 Phone 877-499-6418 Fax 866-635-4523
ACCOUNT VALUE DETAIL AS QF 07/28l14:
Current Fund
Rate Value
3.00% $ 22,643.69
3.00% $ 79,708.21
New effective annual rates for each fund will be determined when the current g�iarantee expires.
If you have any questions concerning your annuity piease contact your representative at your financial institution.
�: .GENERA.L ANNUITY IN�ORMATION
Annuitant: Ronald W Sheaffer
Owner: Ronald W Sheaffer Rosealma B Sheaffer
Issue Date: 07/28/03
Type of Plan: Non-Qualified
Primarv Beneficiary(ies): Percentaqe
Roxanne M Klinger 50%
Rhonda Y Dang 50%
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