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Home My WebLink About06-11-15 s. s 1505610105 REV-1500 EX(02-11)(H)yf!li TLi1�l OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year File Number Bureau of Individual Taxes �' PO BOX 28o6ol INHERITANCE TAX RETURN Harrisburg,PA 17128-o6oi RESIDENT DECEDENT Q � ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 02/23/2015 05/24/1918 Decedent's Last Name Suffix Decedent's First Name MI Shaffer Helen M (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI I I i Spouse's Social Security Number - THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1.Original Return O 2.Supplemental Return O 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) r ) 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�edule O) 1� CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SMOULUME DIRECTEDTO M C_ c C7 Name Daytime Telephone number -- _ . 1 rl cn Andrew C. Sheely, Esquire 717-697-7050 I— i,--, --t d ITS_.. M. 1711 REGISTER OF'WILL'S USE ONLY. O Tt First Line of Address 127 South Market Street co Second Line of Address P.O. Box 95 City or Post Office State ZIP Code DATE FILED Mechanicsburg PA 17055 Correspondent's e-mail address:andrewc.sheely@verizon.net 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.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG TUURE OF PER ONN RESPONSIBLE FOR FILING RETURN DATE ADDRESS Elsie R. Haubert, Executrix 505 Poplar Avenue, New Cumberland, PA 17070 SIGN"E OF PREPARER O R TH EPRESENTATIVE DATE AAA a 41/ 14 Af5DKESS Andrew C. Sheely, Esquire, 12 South Market Street, P.O. Box 95, Mechanicsburg, PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 *3 �� 1505610205 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: Helen M. Shaffer RECAPITULATION 1. ;Real Estate(Schedule A). ..... ... ... .. .......... .. .. ... ... ..... ... . .. 1. i $105,000.00 i 2. Stocks and Bonds(Schedule B) . . .. .. ... ..... .... .... ... ... .. ... . ..... 2. ! $50,819.16 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . .. .. 3. 4., Mortgages and Notes Receivable(Schedule D) . . . .... ...... ... . . ... ...... 4. 1 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).... .. . 5. 334,746.29 6. Jointly Owned Property(Schedule F) O Separate Billing Requested .. ..... 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 8. Total Gross Assets(total Lines 1 through 7). .... ... .. . .. ... ........ .. . .. 8. ! $490,565.45 9. Funeral Expenses and Administrative Costs(Schedule H). ..... .... . .. . .. . .. 9. 13,236.20 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule 1)....... . .... ... 10. 1 3,992.49 11. Total Deductions(total Lines 9 and 10). .. .... .. .. ....... . . .......... ... 11. 17,228.69 12. Net Value of Estate(Line 8 minus Line 11) .. ... .. ..... . .... .. . . . .. ... ... 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which i an election to tax has not been made(Schedule J) ... ....... . .. .. ... ... ... 13. 1. 14. Net Value Subject to Tax(Line 12 minus Line 13) ..... . .. ... ... .......... 14. 473,336.76 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfersunder Sec.9116 -..._-__..___...---....-_.__.._.._....._..... ................._...._._-....-_._._._......., ;.-.__.......__._._......_..___._...__._......._.._.....__.........._.__.._._..__.........._..._..-....._... (a)(1.2)X.0_ 15. 16. Amount of Line 14 taxable i at lineal rate X.0 45 473,336.76 16. 1 $21,300.15 17. Amount of Line 14 taxable at sibling rate X.12 17. 18. Amount of Line 14 taxable at collateral rate X.15 18. i 19. TAX DUE . . . ... ... ... . .. .. . .. ........ .. . . .. . ... . . .... ..... . . . ..... 19. $21,300.15 20. 'FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 s REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Helen M. Shaffer STREETADDRESS 209 Second Street Cin STATE ZIP Summerdale PA 17093 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) $21,300.15 2. Credits/Payments A.Prior Payments $20,000.00 B.Discount $1,052.60 Total Credits(A+B) (2) $21,052.60 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) $247.55 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 ............................................ ❑ 0 c. retain a reversionary interest .............................................................................................................................. ❑ 0 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?.............. ❑ N 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation? ........................................................................................................................ ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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. COMMONWEALTH OF PENNSYLVANIA REV-1162 EX01-96) " DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG,PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 020673 HAUBERT ELSIE R 505 POPLAR AVENUE NEW CUMBERLAND, PA 17070 ACN ASSESSMENT AMOUNT CONTROL NUMBER -------- told __________ -------- 101 $20,000.00 ESTATE INFORMATION: SSN: FILE NUMBER: 2115-0241 DECEDENT NAME: SHAFFER HELEN M DATE OF PAYMENT: 05/15/2015 POSTMARK DATE: 05/15/2015 COUNTY: CUMBERLAND DATE OF DEATH: 02/23/2015 TOTAL AMOUNT PAID: $20,000.00 REMARKS: RCPT TO ATTY CHECK# 113 INITIALS: DB1 SEAL RECEIVED BY: LISA M. GRAYSON, ESQ. REGISTER OF WILLS TAXPAYER .zREV-1502 EX+(11-08) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER Helen M. Shaffer 21-15-0241 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, both 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 Decedent's real estate located at 209 Second Street,Summerdale,Cumberland County, PA, 17093. Tax-Parcel#09-12-2995-077. See attached settlement sheet. $105,000.00 TOTAL(Also enter on Line 1, Recapitulation.) $ $105,000.00 If more space is needed, insert additional sheets of the same size. , A. Settlement Statement U.S.Department of Housing and Urban Development B.Type of Loan I OMB Approval No.2502.0265 1. OFHA 2. OF HA 3. OConv.Unins. 6.File Number 7.Loan Number 8.Mortgage Insurance Case Number 4. ❑VA 5. Conv.Ins. 15-3356NM s rc a ate am"h=, s s. p o ere C.Note: nems marked-(P.o.e.)^were Dab outside the dosing;that am shown hate for information purposes and are rat included in the totals. TitleEXpre$S Settlement System WARNING:It Is a crime to knowingly make false statements to the United States on this of anyother s'unllarform.Penalties upon convtolbn wn br h a the grid Int sor mord.For details see:Title IS U.S.code section 100+and section 1010. Printed 05/26/2015 at 13:44 BG 0,NAME OF BORROWER: Northeast Fire&Rescue Co. ADDRESS: 202 Third Street PO Box 89 Summerdale PA 17093 E.NAME OF SELLER: Estate of Helen M.Shaffer ADDRESS: F.NAME OF LENDER: Riverview Bank and Its Operating Divisions ADDRESS: 200 Front Street P.O.Box B Marysville.PA 17053 G.PROPERTY ADDRESS: 209 Second Street,Summerdale,PA 17093 09.12.2995.077 East Pennsboro Township H.SETTLEMENT AGENT: North Mountain Settlement Services,L.P.,Telephone:717.364.3140 Fax:717.364.3144 PLACE OF SETTLEMENT: 1250 North Mountain Road Harrisburg,PA 17112 1.SETTLEMENT DATE: 1 0512812015 J.SUMMARY OF BORROWER'S TRANSACTION: K.SUMMARY OF SELLER'S TRANSACTION: 100.GROSS AMOUNT DUE FROM BORROWER 400.GROSS AMOUNT DUE TO SELLER 101. Contract sales price 1 105 000.00 401. Contract sales price 105 000.00 102. Personalrort 402. Personal property 103. Settlement charges to borrower line 1400 3,089.00 403. 104. 404. . 105. I 405. Adjustments for items paid by setter in advance Adjustments for items Paid by setter in advance 107. Count taxes 05128115to12131115 211.39 407. County taxes 05128115 to 12131115 211.39 108. School taxes 05128115to06130115 97.86 408, School taxes 05128115to06130115 97.86 109. Sewer 05128115to06130115 51.56 409. Sewer 05128115to06130115 51.56 110. 1 410. 111. t 411. . 112. 1 412. 120.GROSS AMOUNT DUE FROM BORROWER 1 108 449.81 420.GROSS AMOUNT DUE TO SELLER 105 360.81 200.AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500.REDUCTIONS IN AMOUNT DUE TO SELLER 201. Deposit or earnest money 1 2000.00 501. Excess Deposit see instructions 202. Principal amount of new loans 84 000.00 502. Settlement charges to seller line 1400 1,080.00 203. Existin loan s taken sub'ebt to 503. Existing loans taken subject to 204, I 504. Payoff of First Mortgage Loan 205. I 505. 206, I 506. 207. I 507. 208. 508. 209. ! 509. Adjustments for items unpaid by seller. Adjustments for items unpaid by seller 213. 1 513. 214. 514. 215, ( 515. 216. i 516. 217. t 517. 218. 1 518. 219. 1 519. 220.TOTAL PAID BYIFOR BORROWER 86 000.00 520.TOTAL REDUCTION AMOUNT DUE SELLER 1 080.00 300.CASH AT SETTLEMENT FROM OR TO BORROWER 600.CASH AT SETTLEMENT TO OR FROM SELLER 301. Gross amount due from borrower line 120 108 449.81 601. Gross amount due to seller line 420 105 360.81 302. Less amounts paid b/for borrower line 220 86,000.001 602. Less reduction amount due seller line 520 1,080.00 303.CASH FROM BORROWER 22 449.81 603.CASH TO SELLER 104 280.81 SUBSTITUTE FORM 1099 SELLER STATEMENT:The Information contained herein is Important tax information and is Doing furnished to the internal Revenue Service.tt you are required to lite a retum. e rt gollence penalty or other sanction will be Imposed on you It this item is mqukod to be reported and the IRS determines that It has cot been reported.The Contract Sales Price descrbad 01 Ikre 401 above constitutes the Gross Pr000eds of this transaction. Yau are required by law to pmvIde the satuLment agent ifed.Taz tD No: )wkh your eorrcct tazpayar klenHtka7lpn numDor,tf you do not provide your cpmect taxpayer idantificef'wn number,yw may DB subject to CiWI or crhnihat panaittes mposad by taw. n ec Ppedury,[czNH that the number shown an this statement es my arcract taxpayer tdenlircation ncanber. TIN: _ I l SELLER(S)SIGNATURE(S): I SELLER(S)NEW MAILING ADDRESS: { SELLER(S)PHONE NUMBERS: (H) (Vd} REV-1503 EX+(7-11) pennsytvania SCHEDULE B DEPARTMENT OF REVENUE INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER Helen M. Shaffer 21-15-0241 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH I Fulton Financial Corp.common stock- 4,193 shares @$12.12/share at date of death $50,819.16 Certificate Number Number of shares H258171 195 shares H244307 780 shares H230206 77 shares H223017 1,500 shares H217072 73 shares H2O7806 294 shares H191613 56 shares H180630 53 shares H169055 97 shares H152078 194 shares H128016 70 shares H119025 64 shares H99297 58 shares H77183 42 shares H65953 38 shares H57180 35 shares H48445 32 shares H36709 29 shares H27337 146 shares H23391 146 shares H87268 117 shares TOTAL(Also enter on Line 2, Recapitulation) $ $50,819.16 If more space is needed, insert additional sheets of the same size 9 MC harjts From MarketWatch t x TORY BURGH DOESN'T HAVE T114E TO READ MAr_4LLffMJ0UR L TUE WAIL STREET JDlJ NAL. Reatimbitiocs1ly M FULT Basic Chart Advanced Chart Interactive Chart 1 Home Quotes f News Industries Markets tiistt�lcal Clefote� EigReports MarketWatch Search Enter Symbols or Keywords t_ __ _ --- This __ _... This Historical 0u rdtes tool allows you to look up a security's exact closing price. Simply type in the symbol and a historical date to view a quote and mini chart for that security. Enter,Symbol: (FU-LT Enter Date: '[2/23/15 rr Fulton Financial Corp. FULT Daily Mon.Fah 23,2.015 Ctodrg price: 12.19 121 1 Open. 12.11 High 12.18 11.5 Unw: 12.05 volume: ,� 739,498 Fcb Her, i No Splits Sportsored Unks 1. Options Trading Simulator 6. Penny Stocks to Buy �t 2. 5 Stocks to Buy Now 7. Top 10 Income Funds 3. Top Roth IRA 8. Fixed Income Index Funds 4. Best Index Funds 9. 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All quotes are in local exchange time. tt S REV-iSot EX+.(ii-iq) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: .Helen M. Shaffer 21-15-0241 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 Decedents 2004 Saturn,average condition $1 500 2- PNC Bank CD Account#31200071103-$26,779.96 principal,accrued interest$22.23 $26,80219 3. PNC Bank CD Account#31800160348:-$2,668.54,principal,accrued interest$0.04 $2,668.58 4., PNC Bank CD Account#31700239784-$5,734.25 principal,accrued interest$6.4.1 $5,740.66 5. PNC Bank CD Account#31300241445-$5,734.25 principal,accrued interest$6.29 $5,740.54 6. PNC Bank CD Account#31400247495-$11,814.15 principal,accrued interest$0.65 $11,814.80 7, PNC Bank CD Account#31800247087-$2,897.88 principal,accrued interest$1.69 $2,899 57 & PNC Bank CD Account#31100186584-$11,757.06 principal,accrued interest$0.81 $11,757.87 9., PNC Bank Checking Account#5140114424-$10,154.05 principal,accrued interest$0.05 $10,154.10 10. PNC Bank Savings Account#5004135079-$47,673.90 principal,accrued interest$0.47 $47,674.37 11. Highmark refunds $117.08 12. Erie Insurance $151.00 13. Verizon refund $15.82 Morgan Stanley Account#410-061047-073-date of death value 14. $207,709.71 334,746.29 TOTAL(Also enter on Line 5, Recapitulation) $ If more space is needed,use additional sheets of paper of the same size CERTIFICATE OF TITLE FOR A"VEKfCLE M 3tFi. ;- - _ - _ Ga. _ SE"L:' ItP P'F:GR"TTIiE S*'ATE' t.e?OCD-4a :0"mv Qom '�E �.t1tEr "•~:�:.bD^t��STi�•i�i"^'" I ,F Y 'lic E%" Ir�""�•ft AVt'.r•_LJ�:�'.. ��/YV v ... J vSr 1;$ .}Jpi 9"E 'LTJ n1 AfY_t iC 14'r EN N S14AFFER ico SSP• 6 _L-f �. 41 GX .1 116 L wcWuJe vi Nlc< ' .i-'NAs a PUUCF VE-K�LE SUMMERDALE PA 1701-3 as e ccr.:tsuc:r�, • T k.[.r:C`+:F Rf-,�We, VE.HK;1_t" v V V('••.'.X:: w FIRS, Y _ � ��.::3v mu.� ewc,3? : TG,r�9Y E.0-., � Yvt L�s,:�� t�'i•„ '� I F I i IEN PtaAPC ' ' " .r.b -•a f�- - I SEM%3 u84 R>:y- �`att►1r�R� rra7rvE A MAILING AW RESS • AUTROR®-AEPRESFfrKITIM -_ KELEN K SHAFFER 209 2-ND ST aux 1118 SUS MEROALE FA 171313 - d am.tk oC,a,!mooed'. d MVyS"dn D-p rtw-1 ALLEN Q BIB LIER l: - C�FN sw. *".tsi'Q. 1'ry%WCIAC$i, R9r9 tr.!iTed'f�t,:'rr�mT - -_ - Sceae3erj of�l".nRi[>rrRHilJw L APPLICATIONi6 COLIPLETED BY PURCHASER WHEN VEHTCLE IS SOLD AND, THE 1 ' TITLE AND LIEN INFORMATION HSCFllFiF.tJ ANO SWORN ., n p>•purd4r.c`r athur th2A your;,polrC.e i"fisted end you wam the title to - O L+FORE ME _ �,.�_ i W iislv0 a:; d09ut Ten;taE,N11tta Fight of Sw:rvNgry,ltipP(Qn death of one p ntr,,Mie qoc tD sJ:m,"own,,f.!CH rwi othese.a,mt. - W11;lie issued as'Teir]tft in COnr�a cfea o aro tumor,mleresI of ' deceasLd owner goes to tri>bt*r heyg,�_pF raateJ . NO t • _ =""I� - .£A3hnJu7At IrS'17TUTiOh KJ7d8ER N 2W7 WEN 14.17E ; ,F NO 1191,ChiECK r 2N;,C i=NHC,i>Eki O 't - - -' CITY $TAr•t P co RVVI{,ryly 1-I&SMV1102%M.AIUIER t� Mar. 9. 2015 2:49PM No, 0091 P. 1/2 II&PNC March 9,2015 Andrew Sheely Attorney At Law PO Box 95 127 S Market Street Mechanicsburg FA. 17055 RE: Helen M Shaffer SSN: 193-36-3262 DOD: 02-23-2015 Dear Ms. Sheely: In response to your request for Date of Death(DOD)balances for the customer noted above,our records show the following: Certificate of Deposit Account#31200071103 Established: 01-06-1997 HELEN M SHAFFER DOD balance: $26,779.96+22.23 accrued interest Account#31800160348 Established: 07-19-1999 HELEN M SHAFFER DOD balance: $2,668.54+0.04 accrued interest Account 9 31700239784 Established: 05-28-2004 HELEN M SHAFFER DOD balance: $ 5,734.25+6.41 accrued interest Account#31300241445 Established: 06-02-2004 HELEN M SHAFFER DOD balance: $ 5,734.25 +6.29 accrued interest Account#31400247495 Established: 09-15-2004 HELEN M SHAFFER DOD balance: $ 11,814.15+0.65 accrued interest Account#31800247087 Established: 10-05-2004 HELEN M SHAFFER DOD balance: $2,897.88+1.69 accrued interest Page 1 of 2 Mar, 9. 2015 2:49PM No, 0091 P. 2/2' Account#31100186584 Established: 05-09-2000 HELEN M SHAFFER DOD balance: $ 11,757.06+0.81 accrued interest Checlung Account Account#5140114424 Established: 04-04-1989 HELEN M SHAFFER DOD balance: $ 10,154.05 +0.05 accrued interest Savings Account Account# 5004135079 Established: 11-06-2002 HELEN M SHAFFER DOD balance: $47,673.90+0.47 accrued interest Safe Deposit Boz The decedent maintained safe deposit box#00292 HELEN M SHAFFER SANDRA L SHAFFER Located at:Enola Branch o 235 N Enola Rd Enola PA 17025 (717)732-5388 Please note that this office provides date of death balances for deposit accounts(]RAs,CDs,Checking and Savings)_ We do not process any financial transactions or provide statements. If you need assistance with any of these items,please call 1-888-PNC-BANK(1-888-762-2265)or stop by your local PNC Bank branch office. Sincerely, National Financial Services Center PNC Bank,N.A. Member FDIC This message is intendedfor the use of the individual or entity to which it is addressed and may contain information that is privileged confidential and exempt from disclosure under applicable law. If the reader of this message is not the intended recipient or the employee or agent responsible for delivering this message to the intended recipient,you are hereby notified that any dissemination, distribution or copying of this communications is strictly prohibited If you have received this communication in error,please notify me immediately by reply or by telephone at 800-762-.1775 and immediately destroy this faxed document. Page 2 of 2 r: Gain& Loss: Unrealized ELSIE R HAUBERTEXEC ELSIE R HAUBERT EXEC Morgan Stanley As of 08:17 AM EST,04/15/2015 EST OF HELEN M SHAFFER EST OF HELEN M SHAFFER 410-061047-073 AAA 505 POPLAR AVENUE Estate NEW CUMBERLAND PA 17070 $212,590.33(prev.close)/Standard (717)774-2713 (H) SECURITYA QUANTITY DATE ACQUIRED UNIT COST($) TOTAL COST(S) ADJUSTED COST(S) MARKET VALUE($) G/L AMOUNT($) HOLDING PERIOD MUTUAL FUNDS i Market Value:$207,709.71 American Cap Wdd Gr&Inc A 308.000 02/23/2015 48.10 14,814.80 A,l 14,814.80 14,913.36 98.56 long adj 2015-04-13 82.678 02/23/2015 48.10 3,976.81 PJ 3,976.81 4,003.27 26.46 long adj 2015-04-13 486.806 02/23/2015 48.10 23,415.37 PI 23,415.37 23,571.15 155.78 long adj 2015-04-13 Total Purchased Shares 877.484 $48.10 $42,206.98 Dividend Reinvestment 0.225 02/23/2015 48.09 10.82 A,I 10.82 10.89 0.07 long adj 2015-04-13 Dividend Reinvestment 0.233 02/23/2015 48.11 11.21 A,I 11.21 11.28 0.07 long adj 2015-04-13 Dividend Reinvestment 0.444 02/23/2015 48.11 21.36 A,I 21.36 21.50 0.14 long adj 2015-04-13 Dividend Reinvestment 0.522 02/23/2015 48.10 25.11 A,I 25.11 25.28 0.17 long adj 2015-04-13 Dividend Reinvestment 0.678 02/23/2015 48.10 32.61 A,I 32.61 32.83 0.22 long adj 2015-04-13 Dividend Reinvestment 0.853 02/23/2015 48.10 41.03 A,I 41.03 41.30 0.27 long adj 2015-04-13 Dividend Reinvestment 1.000 02/23/2015 48.10 48.10 A,I 48.10 48.42 0.32 long adj 2015-04-13 Dividend Reinvestment 1.706 02/23/2015 48.10 82.06 A,I 82.06 82.60 0.54 long adj 2015-04-13 Dividend Reinvestment 2.000 02/23/2015 48.10 96.20 A,1 96.20 96.84 0.64 long adj 2015-04-13 Dividend Reinvestment 3.000 02/23/2015 48.10 144.30 A,1 144.30 145.26 0.96 long adj 2015-04-13 Dividend Reinvestment 3.000 02/23/2015 48.10 144.30 A,i 144.30 145.26 0.96 long adj 2015-04-13 Dividend Reinvestment 11.600 02/23/2015 48.10 557.96 A,l 557.96 561.67 3.71 long adj 2015-04-13 Dividend Reinvestment 24.000 02/23/2015 48.10 1,154.40 A,I 1,154.40 1,162.08 7.68 long adj 2015-04-13 Dividend Reinvestment 38.469 02/23/2015 48.10 1,850.36 A,I 1,850.36 1,862.67 12.31 long adj 2015-04-13 Dividend Reinvestment 43.679 02/23/2015 48.10 2.100.96 A,I 2,100.96 2,114.94 13.98 long adj 2015-04-13 Dividend Reinvestment 47.000 02/23/2015 48.10 2,260.70 A,I 2,260.70 2,275.74 15.04 long adj 2015-04-13 Dividend Reinvestment 79.680 02/23/2015 48.10 3,832.61 A,I 3,832.61 3,858.11 25.50 long adj 2015-04-13 Fund Total 1,135.573 48.10 54,621.07 54,621.07 54,984.45 363.38 Mkt Value vs.Total Purchases $42,206.98 $54,984.45 Net Value Increase/(Decrease)# $12,777.47 American Inc Fd Of America A 330.000 02/23/2015 22.14 7,306.20 &1 7,306.20 7,240.20 -66.00 long adj 2015-04-13 360.577 02/23/2015 22.14 7,983.17 A,I 7,983.17 7,911.06 -72.11 long adj 2015-04-13 637.000 02/23/2015 22.14 14,103.18 A,I 14,103.18 13,975.78 -127.40 long adj 2015-04-13 1,029.024 02/23/2015 22.14 22,782.59 A,I 22,782.59 22,576.79 -205.80 long adj 2015-04-13 257.181 02/23/2015 22.14 5,693.99 PJ 5,693.99 5,642.55 -51.44 long adj 2015-04-13 1,659.869 02/23/2015 22.14 36,749.50 PI 36,749.50 36,417.53 -331.97 long adj 2015-04-13 Total Purchased Shares 4,273.651 $22.14 $94,618.63 Dividend Reinvestment 0.098 02/23/2015 22.14 2.17 A,I 2.17 2.15 -0.02 long adj 2015-04-13 Dividend Reinvestment 0.522 02/23/2015 22.15 11.56 A,I 11.56 11.45 -0.11 long adj 2015-04-13 Dividend Reinvestment 0.523 02/23/2015 22.14 11.58 A,I 11.58 11.47 -0.11 long adj 2015-04-13 Dividend Reinvestment 0.926 02/23/2015 22.14 20.50 A,I 20.50 20.32 -0.18 long adj 2015-04-13 P:When there is a"P"next to a transaction,this indicates that you have provided the trade history for this transaction;it was not available through Morgan Stanley Smith Barney LLC records. Page 1 of 2 #-Net Value Increase/(Decrease)compares your Total Purchases(excluding Dividend Reinvestments)with the Market Value of all shares you hold of the fund.This calculation is for informational purposes only,does not reflect your total unrealized gain or loss and should not be used for tax purposes. H-Wash sale rules apply to this tax lot.The cost basis has been adjusted to account for disallowed loss of a related wash sale transaction for this covered security. I-This tax lot has been marked as inherited.Cost basis,acquisition date and holding period have been adjusted accordingly. G-This tax lot has been marked as a gift. Gift basis rules will apply at the time of sale. A-Information for this transaction reflects your requested adjustments to existing Morgan Stanley Smith Barney LLC trade history. B-This adjusted cost figure is for reference purposes only.It is based on the assumption that the deposit note value has not changed since the issuance.This assumption may not apply to you.Please review with your tax advisor on what is the best method for allocating cost basis for your account. E-This transaction was executed elsewhere and the securities were later transferred to your Morgan Stanley Smith Barney LLC account.The trade history for this transaction was provided to Morgan Stanley Smith Barney LLC by your prior financial institution. M-Options exercise and assignments include options premiums when determining the realized gain and loss. Gain &Loss: Unrealized ELSIE R HAUBERT EXEC Morgan Stamey As of 08:17 AM EST,04/15/2015 EST OF HELEN M SHAFFER 410-061047-073 AAA SECURITY♦ QUANTITY DATE ACQUIRED UNIT COST(S) TOTAL COST($) ADJUSTED COST($) MARKET VALUE(S) G/L AMOUNT(S) HOLDING PERIOD Dividend Reinvestment 2.000 02/23/2015 22.14 44.28 A,I 44.28 43.88 -040 long adj 2015-04-13 Dividend Reinvestment 12.265 02/23/2015 22.14 271.55 A,I 271.55 269.09 -2.46 long adj 2015-04-13 Dividend Reinvestment 16.000 02/23/2015 22.14 354.24 A,I 354.24 351.04 -320 long adj 2015-04-13 Dividend Reinvestment 40.000 02/23/2015 22.14 885.60 A,I 885.60 877.60 -8.00 long adj 2015-04-13 Dividend Reinvestment 64.000 02/23/2015 22.14 1,416.96 A,I 1,416.96 1,404.16 -12.80 long adj 2015-04-13 Dividend Reinvestment 87.619 02/23/2015 22.14 1,939.88 A,I 1,939.88 1,922.36 -17.52 long adj 2015-04-13 Dividend Reinvestment 103.209 02/23/2015 22.14 2,285.05 A,I 2,285.05 2,264.41 -20.64 long adj 2015-04-13 Dividend Reinvestment 200.694 02/23/2015 22.14 4,443,37 A:I 4,443.37 4,403.23 -40.14 long adj 2015-04-13 Fund Total 4,801.507 22.14 106,305.37 106,305.37 105,345.07 -960.30 Mkt.Value vs.Total Purchases $94,618.63 $105,345.07 Net Value Increase/(Decrease)# $10,726.44 First Eagle Global C 299.838 02/23/2015 52.99 15,888.42 A,1 15,888.42 15,969.37 80.95 long adj 2015-04-13 Fund Total 299.838 52.99 15,888.42 15,888.42 15,969.37 80.95 Mkt Value vs.Total Purchases $15,888.42 $15,969.37 Net Value Increasel(Decrease)# $80.95 Thornburg Inv Inc Builder C 1,430.365 02/23/2015 21.63 30,938.79 A,I 30,938.79 31,410.82 472.03 long adj 2015-04-13 Fund Total 1,430.365 21.63 30,938.79 30,938.79 31,410.82 472.03 Mkt Value vs.Total Purchases $30,938.79 $31,410.82 Net Value Increase/(Decrease)# $472.03 Total Mutual Funds $207,753.65 $207,753.65 $207,709.71 443.94 Total Unrealized Gain/Loss $207,753.65 $207,753.65 $207,709.71 -$43.94 The gain and loss information is provided for informational purposes only,is not a substitute 1099 form(or any other appropriate tax form),and should not be used for tax preparation.Unrealized gain and loss values are estimates and should be independently verified.Morgan Stanley does not provide tax advice.We recommend that you contact your tax advisor to determine the appropriate use of this information.Past performance does not guarantee future returns. Gain and loss information is calculated based upon uniform standards and does not account for each individual client's particular circumstances such as the existence of hedging transactions or constructive sales.Although we make every effort to adjust the cost basis for securities'capital changes,we do not adjust the cost basis for all events.Contact your Financial Advisor for guidance on particular questions. For accounts with Choice Select pricing,the commissions paid on your eligible equity and option purchases and sales are applied to the Total Cost on a monthly basis. With respect to estimated gains and losses for listed equity options,we have taken into account option premiums paid or received and,in respect to multiple purchases and/or sales,calculated cost using an average unit price for all like positions. We are not responsible for any gain and loss information provided by you or another financial institution;you are responsible for ensuring the accuracy of such information.Whether provided by you,another financial institution or Morgan Stanley,it is your responsibility to ensure the accuracy of all of the Estimated Gain and Loss information. For clients wishing to make versus purchase sales that information needs to be conveyed at the time of the sale.Unless you tell us otherwise,we use first in first out(FIFO)accounting. P:When there is a"P"next to a transaction,this indicates that you have provided the trade history for this transaction;it was not available through Morgan Stanley Smith Barney LLC records. Page 2 of 2 #-Net Value Increase/(Decrease)compares your Total Purchases(excluding Dividend Reinvestments)with the Market Value of all shares you hold of the fund.This calculation is for informational purposes only,does not reflect your total unrealized gain or loss and should not be used for tax purposes. H-Wash sale rules apply to this tax lot The cost basis has been adjusted to account for disallowed loss of a related wash sale transaction for this covered security. I-This tax lot has been marked as inherited.Cost basis,acquisition date and holding period have been adjusted accordingly. G-This tax lot has been marked as a gift. Gift basis rules will apply at the time of sale. A-Information for this transaction reflects your requested adjustments to existing Morgan Stanley Smith Barney LLC trade history. B-This adjusted cost figure is for reference purposes only.It is based on the assumption that the deposit note value has not changed since the issuance.This assumption may not apply to you.Please review with your tax advisor on what is the best method for allocating cost basis for your account. E-This transaction was executed elsewhere and the securities were later transferred to your Morgan Stanley Smith Barney LLC account.The trade history for this transaction was provided to Morgan Stanley Smith Barney LLC by your prior financial institution. M-Options exercise and assignments include options premiums when determining the realized gain and loss. REV-1511 EX+(10-09) pennsytvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Helen M. Shaffer 21-15-0241 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1, Richardson Funeral Home $6,280.90 2. Rolling Green-grave opening $225.00 3. Summerdale Church $100.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: $0.00 Name(s)of Personal Representative(s) Elsie R. Haubert Street Address 505 Poplar Avenue City New Cumberland state PA ZIP 17070 Year(s)Commission Paid: 1 Attorney Fees: Ayl*e U-) (f /-)eC--/Y) afob— $5,500.00 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: $520.50 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. Postage,Certified Mail 9.80 8. Reserves to conclude Estate administration,final accountings 600.00 TOTAL(Also enter on Line 9, Recapitulation) $ 13,236.20 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+(12-08) r , pennsylvania SCHEDU .E I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, - INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Helen M. Shaffer 21-15-0241 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. Superior Plus Energy Service- final bill $1,054.55 2. AAA Financial Service-final bill $367.33 3. PA America Water-final bill $53.17 4. PPL-final bill $106.55 5. CBL Path-Highmark deductible $42.34 6. Decedent's 2014 Federal income tax due $175.00 7. Debbie Lupold,Tax Collector -2015 Real estate and municipal taxes $358.84 8. Decedent's 2014 PA Income tax due $238.00 9. AT&T-final bill $21.14 10. East Pennsboro Township-sewer $138.00 11. Pete's Bridge Street Motors-title transfer of vehicle $129.00 12. Paul Haubert-misc,repairs/broken door $36.49 13. State Farm Insurance-lost bond for stock certificate $120.00 14. Settlement charges for sale of 209 Second Street,Summerdale,PA 17093,per settlement sheet $1,080.00 15. Amerigas-final propane bill for tank rental $72.08 TOTAL(Also enter on Line 10, Recapitulation) $ 3,992.49 k If more space is needed,insert additional sheets of the same size. i i REV-1513 EX+(01-10) 3 "_" jB , pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Helen M. Shaffer 21-15-0241 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. Donella R.Shaffer,2327 South Gillinger Road,Lafayette Hill, PA 19444 Daughter 25% 2. David A.Shaffer, 102 Spruce Street,Carlisle,PA 17013 Son 25% 3. Sandra L.Newmyer, 705 Forest Glen Road, Silver Spring, MD 20901 Daughter 25% 4. Elsie R.Flaubert,505 Poplar Avenue,New Cumberland, PA 17070 Daughter 25% ,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 OF HELEN M. SHAFFER I, Helen'M. Shaffer, of Summe' rdale, Cumberland County; Pennsylvania,'declare this-to be my last Will and hereby revoke all prior Wills and Codicils'. 1.. . I'direct that all my'just debts, funeral expenses, ' gravemarker and administrative expenses shafl be paid"` from my residuary estate as soon as practicable after my death. 2. . 1 direct that all,inheritance, estate; transfer, succession and death•taxes of any kInd w�iatsoever Which may be 'pa'yable by reason of my death shall'be-paid out of my residuary estate. 3. . 1 direct that my entire estate•tie distributed in four equal. shares to my children, Elsie R. Haubert, Sandra L. It Newmyer, David A. Shaffer and Donella R. Shaffer. If any of my children should predecease me, their share shall be distributed to their children. If.there are no'children, : their.share*sh" 11 Iapse and go my to remaining children. 4. 1 appoint Elsie R. Haubert as Executrix of this my last :Will. If she should predecease me or•cease to act in such capacity, I appoint Qonella R. Shaffer as alternate. . 5.. The Executrix of this Will shall have the' ower to distribute my estate in kind or in cash, or partly in either. B. I direct that no Executrix acting under this Will shall be wed-to enter bond•in any jurisdiction: .. ... : -... IN.WITN HEREOF, .1 have hereunto set my.hand this',:;-' day of 12003. Helen M. Shaffer LAW 4FFIMS 4F STEPHEN J.HOGG 19 S.HANOVER STREET., f SUITE 101 CARUSLE,PA 17013 ,. The preceding instrument consisting of this and one other page was on the day and date hereof signed, published and declared by' Helen M. Shaffer, as and for her last Will.in the presence of us, who at her request, in his presence and in the presence of each other have subscribed our names as witnesses hereto. !-NESS WITNESS . • LAW OR-098 OF iTEPBrly J.HOGG 19 S.HANOVER STREET SUITE 101 CARLISLE,.PA 17013 ACKNOWLEDGMENT State of Pennsylvania ss County of Cumberland I, Helen M. Shaffer the 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 as my free and voluntary act for the purposes therein expressed. ----------------- Helen M.. Shaffer Sworn to or affirmed and acknowledge' before rime by Helen M. Shaffer, the testatrix, this - - day of 2003. l NOTARWl.SEAL .1�i� G..JMAOirrptIBl.Mc Notary Public/A ey CMY/�AA/�R{}}�,i��lS��t.E��yEyX�,�`�. ��7�w8�EFtLANEPTEpO�00.PA AFFIDAVIT State of Pennsylvania ss County of Cumberland We,.Coera d& and Ltsa-W, '��'�1&.-L:' , the witnesses whose names arA�Sie d to the attached or foregoing witnesses whose names ar instrument, being duly qualified according to law, do depose and say that we were'present and,saw the testatrix sign and execute the instrument as her last Will; that the testatrix signed willingly and executed it as her free and voluntary act for the purposes therein- -expressed,, herein•-expressed,fhat each,subscribing witness in the hearing and-sight-a# the testatrix signed the Will as a witness; 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. Aliq ALA4 �.�. =N Sworn to or affiFpeo and subscribed.0 beforeme by witnesses, this 2Z--day of LAW CtFFfCEB OF 4ta TEPHENJ.HOGGumclAttoe NOTARrA1.SEAL18 S.HANOVER STREET y' SUITE-101 ire J.WOC,MrARY FiUSU6 CARLISLE,PA 17013. CAAL4ME RARC CUUBEFUJM CO,PA MY "EXPOMS SEPtEBHOM&2M