HomeMy WebLinkAbout01-0277
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Estate of Kathryn E. Sheaffer
also known as N/A
PETITION :FOR PROBATE and GRANT OF LETTERS
/.", I .r, I .., 7]
."\ t - C' I - L
Register of Wills for the
. Deceased. County of in the
Social Security No. 187-1 h-6564 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execut rix
in the last will of the above decedent, dated 23 ~pr; 1
and codicil(s) dated None
No.
To:
named
,19~
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
h
Decendent was domiciled at death in 0 lTTlllPr 1 ;:lllc1 County, Pennsylvania, with
pr last fam.,i)y or principal residence at 1858 Ho 11 Y Dr; \TP ; n Camp Hill
;U.-I.UJA.(J.PO(A^_ [(Hf. .
(list street, number and rnunclpahty)
Decendent, then _..a~ years of age, died
at
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent: N/A
Decendent 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 . $ 85,000.00
situated as follows: 1858 Holly Drive, Lower Allen Tawnshlp, ('nrrihpyland County,
ppnnsylvania
27 January
2001
50,000.00
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
pre..ented herewith and the grant of letters testamentary
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
theron.
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OA.TH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA l s~
COUNTY OF Cumberland J ~
The petitioner(s} abovf-na'med swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the be~::t 01 the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
. )~. ,:~~
M ~. S eaffer
( (y -- 2/ 7 - 2.
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No.
Estate of
Kathryn E. Sheaffer
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
~o
AND NOW 13 n112 R(~ H- y( 0 ( , in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented b_efore me,
IT IS DECREED that the instrument(s) dated 23 April 1996
described therein be admitted to probate and filed of record as the last will of Kathryn E. Sheaffer
and Letters t-p~rrlmpn+-;HY
are hereby granted to Mary' E. Sheaffer
uLL~~~
Samuel L. Andes, Supreme Court ID 17225
ATTORNEY (Sup. Ct. I.D. No.)
525 North 12th Street, Lemoyne, Pa 17043
FEES
Probate, Letters, Etc. ......... $ ~OO. 00
ShxI!~(rg;~cates(G) .......... $ I ~ .no
ReRHlh..JlJUU ................ $ l.LJ .()O
JCP $ 0;00
TOTAL _ $~Jq I OC)
Filed . J .--. (3 ~ O./. . . . . . . . . . . . . . . . . . . . . . .
ADDRESS
(717) 761-5361
PHONE
film LLf TO A TT()~ E 'Y_
-!ll\C Q(\'::
This is to certifY that the information here given is correcrly copied frO~1 an original ce,~tificate of death du~~ flied with me as
Local Registrar. The original certificate will be forwarded to the State Vltal Records Ofhce for permanent hlll1g.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
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Fee for this certitlcate, $2.00
Local Registrar
P 7175660
JAN 3 0 2001
No.
Date
:3 Rev 2187
COMMONWEALTH OF PENNSYLVANIA. OEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
Ie.
SEX
STATE F'LE NUMBER
SOCIAL SECURITY NUIolBER
NAME OF DECEDENT (F "sr. MO<ldIe. L....l
E. Sheaffer
UNDER 1 YEAA UNDER I 011:1
MonIhII Dayll Houd Minul..
2. Fanale 3. 187 - 16 - 6564
27,2001
5.88
COUNTY OF OEAI'H
BIRTHf'Ul.CE ,Cory and PlACE OF DEATH (C~ecll OOly I)ne -- """ .nstruct.ons on """'. '5><lel
Sial..'" Fcre'9tlCounIlY) HOSPITAL:
7. Camp Hill Pa ~lt.n1 0 ER/Ouq)a..anl 0
FACILITY NAME (II nOII,,!.N\J~on. gIVe Slreef aM number.
=.IyIO
....
RACE - Ameocao Illdian.lIlack. Whil.. etc.
(Specoly)
10. White
SURVIVING SPOUSE
I" ",,-, Qf"" mat08n name,
DECEDENT'S USUAL OCCU~
(~:"~/if~:i..~u:'~:i
. l1.?ecretary 111t. Federal Gov I t
DECEDENT'S MAILING ADORESS (SIt..... CilyllOwn. SlaIe, Zop Code) DECEDENT'S
ACTUAL
RESIDENCE
(See IOSIructlOO$
on OIhe, Sldel
17a. Slala
Pa
Did
decedent
Iiw on a
Cunberland 1OWnShip? 17..0 ~=-~o,
MOTHER'S NAME iF.... M<l<lIe, MalOen Su'namtl)
11. Edna Drawbau h
INFORMANT'S IoolAIlINO AOORESS (S1,..1. CoIylTown, Slate, Zip C'-I
2Gb. 903 Lisburn Road Hill, Pa 17011
PlACE OF DISPOSITION. N4me 01 Cemetery. Cremalory LOCRION . CityfTown. Sial.. riP Code
Of 01'* Placa
r.p
17b. Cou
ClIyIboro
"->oval "om Sla,. 0
21c. Mt
M_ 24.211_ be completed by
. I*mrl whO pronounc:ea death.
24. M. 25.
17. PI\RT I: Ellla' ,he diHases. i"Ju,1eS or complocallOflS which caused lhe dea'h 00 nola"ter lhe
LISt only 0'" cause OIl aach k...
IIIIIEOlATE CAUSE (f>nal
.- 01 concldoon
'-.IonQon_l_
0Vf TO (00 t...~~t!{:a ~
Other sigl>iftcenl condlIiona c:onIribuling 10 death, Ilu1
ROI resulting in the underlying <:awe 0iYan in f'IIUIT I.
I
~lI8IcondiI~
iI anr.1Mcling 10 imm<odiaI.
_. Enlar UNOEIlLYIHG
CAUSE (00seaM 01 ...y
...~-
'-*'0 on _I LAST
DUe TO (00 AS A CONSEOUENCE Of):
DUE 10(00 AS A CONSEOUENCE OF}:
~ AJ4 AUTOPSY
PERFORMED?
d
WERE AUTOPSY FINDINGS
AlaIlA8LE PRIOR 10
COMPLETION OF CAUSE
OF DENH7
IoIANNER OF DEATH
Natural
us..
o
o
DATE OF INJURY
(Monlh. Day, Year)
TIME OF INJURY
INJURV J(f WORK?
';lESCRJBE HOW INJURY OCCURRED.
Homoclde
o
o
o PLACE OF INJURY. AI home, fa,~.O:;eet. faC1ory. offic.
building. ate. ,Spec.ly)
:JOe.
Yea 0 No~
M. 3CIc.
Accldenl
Pen(hng Invesaigation
YeaO
No~
Vas 0
No~
Suicide
Could no! be determined
REGISTRAR'S SIGNATURE AND NUMBER
~~
I~/~//I
2Ia. 21b.
CERTIFIER ,Check only one.
.CERTIFYING PHYSICIAN (PhySICliln cer.Jfy>ng cause of dealh whe~ anal"er physoc.an has pronounced death ano completed lIem 23)
To.... Ileal Of my knowladge. death occurr.., due 10 tha c.u.e(al end manna, a. slated. . , . . . . . . . . . . . . . , . . . .
as.
. PRONOUNCING AJ40 CERTIFYING PHYSICIAN IPh""""",, bolt> ."onouflC'''9 oeath and Cer1.ly"'9 to cause of deathl
To the Ileal of my knowledge. daath occurr.., al the lima, da... and plac.. and due 10 Ilia nUMe.) and manna,.. alalad.. , . . . , . . . . . . . . . . . .
'MEDICAL EXAMINER/CORONER
~::''':~:C::=~.i~~~I~~.a.ndI~ ~~~~~t~~~I.j~~: in ~.y. ~~i.n.i~~: ~~~~~ ~~~~~~~~ ~~ I,~~ ~I~~..~~'~: ~~~.~Ja~~: ~~.~~~ t~ I~~ ~~u~~~l.~~~ 0
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1IXLL
01'
KMmtD Z. SBBAI'ftR
I, KATHRYN E. SHEAFFER, of Lower Allen Township, Cumberland County,
Pennsylvania, declare this to be my last will and revoke any will
previously made by me.
ITEM I. I direct that all my just debts and funeral expenses,
including my gravemarker and all expenses of my last illness, and any and
all taxes and assessments imposed by any governmental body as a result of
my death, whether on property passing under this will or otherwise, shall
be paid from my residuary estate as soon as practicable after my decease
as a part of the expense of the administration of my estate.
ITEM II. I direct my personal representative to divide among those
of my nieces and nephews, including great-nieces and great-nephews, as
survive my death, those items of household furnishings and goods,
jewelry, and other articles of household and personal use, equipment and
ornament, as my personal representative, in her sole discretion, deems
appropriate. My personal representative shall have no obligation to
distribute such items to all of my nieces or nephews or great-nieces or
great-nephews or to make such distribution equal, in value or in number,
and the decision of my personal representative on such matters shall be
conclusive and binding on all parties.
ITEM III. I give, devise, and bequeath all the rest, residue, and
remainder of my possessions and estate of every nature and wherever
situate as follows:
A. One-third thereof to my brother, GEORGE C. SHEAFFER,
provided he survive my death by thirty (30) days and, if he
does not so survive my death, then to such of his children as
survive my death by thirty (30) days;
B. One-third thereof to my sister, GAIL F. KECKLER,
provided she survive my death by thirty (30) days and, if she
does not so survive my death, then to such of her children as
survive my death by thirty (30) days; and
1
.'
.'
~
~,
, ..,
c. One-third thereof to my niece, BARBARA S. BOURDETTE,
provided she survive my death by thirty (30) days and, if she
does not so survive my death, then to such of her children as
survive my death by thirty (30) days.
ITEM IV. I appoint my sister-in-law, MARY E. SHEAFFER, executrix of
this my last will.
ITEM V. I direct that my personal representatives and fiduciaries
shall not be required to give bond for the faithful performance of their
duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand this 23 ~
, 1996.
day
of ~t
) rr ~
\\ ()k"k L " ~
KATHRYN ~SHEAFFER .
The preceding instrument, consisting of this and one other
typewritten page, each identified by the signature of the testatrix was
on the date thereof signed, published, and declared by KATHRYN E.
SHEAFFER, the testatrix therein named, as and for her last will, in the
presence of us, who at her request, in her presence, and in the presence
of each other, have subscribed our names as witnesses hereto.
~
amuel L. Andes
2
..-
COMMONWEALTH OF PENNSYLVANIA )
( SS.:
COUNTY OF CUMBERLAND )
The undersigned, being the testatrix whose name is signed to the
attached or foregoing instrument, having been duly qualified according to
law, does hereby acknowledge that I signed and executed the foregoing
instrument as my last will, that I signed it willingly; and that I signed
it as my free and voluntary act for the purposes therein expressed.
--.k~ ~>~
KATHRYN~HEAFFER "
Sworn or affirmed to and acknowledged
before me by the testatrix named above
this 23 r9-- day of Ap,e, l ,1996.
/.. ~~
Nota y Public
COMMONWEALTH OF PENNSYLVANIA )
( 8S.:
COUNTY OF CUMBERLAND )
WE, SAMUEL L. ANDES and J. BART DeLONE, the witnesses whose names
are signed to the attached or foregoing instrument, being duly qualified
according to law, do depose and say that we were present and saw the
testatrix sign and execute the instrument as her last will; that she
signed it willingly and that she executed it as her free and voluntary
act for the purposes therein expressed; that each of us in the hearing
and sight of the testatrix signed the will as witnesses; and that to the
best of our knowledge, the testatrix was at that time 18 or more years of
age, of sound mind, and under no constraint or undue influence.
~
ItMl!c/~
~ art DeLane
Sworn or affirmed to and
acknowledged before me this
23rs.. day of o/~I'J , 1996.
\.. -~/
j~~
Nota y Public
Nc1ZJrtaI Seal
""'" ~ NotaIY P\dC
==~~
"
E'
----
CERTIFICATION OF NOTICE UNDER RULE 5.6Ca)
Name of Decedent:
Date of Death:
Will No.
Kathryn E. Sheaffer
27 January 2001
Admin. No. 21-01-0277
To the Register:
I certify that notice of beneficial interest required by Rule 5.6{a) of the
Orphans Court Rules was served on or mailed to the following beneficiaries of the
above-captioned estate on 9 March 2001 .
Name
Address
Mr. George C. Sheaffer
340 North Front Street, Wormleysburg, PA 17043
Ms. Barbara S. Bourdette
15 Cedarhurst Lane, Camp Hill, PA 17011
Ms. Donna Whitesell
6220 Black Hill Road, Lodi, Wisconsin 53555
Ms. Diane Roddy
2577 Valley Road, Marysville, PA 17053
Ms. Debra Enders
1070 Cemetary Road, Marysville, PA 17053
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except:
None
Date: 3)!610\
~~~
Signature
Name:
Address:
Samuel L. Andes
525 N. 12th Street
Lemoyne, PA 17043
Telephone # 717761-5361
Capacity:
Personal Representative
~ Counsel for Personal
Representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
-
1&, /J J'7 - A
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 01-0277'~
01122467
05-01-2001
REV-1543 EX AFP (09-00)
EST. OF KATHRYN E SHEAFFER
5.5. NO. 187-16-6564
DATE OF DEATH 01-27-2001
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
[X] CHECKING
o TRUST
o CERTIF.
GEORGE C SHEAFFER
1858 HOLLY DR
CAMP HILL PA 17011
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
ALLFIRST FINANCIAL SERVICE has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of Pennsylvania. Que~tions may be answered by Calling (7i7J 787-8327.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 77350251 Date 04-28-1982
Established
Account Balance
Percent Taxable
Amount Subject to
Tax Rate
Potential Tax Due
To insure proper credit to your account, two
(2) copies of this notice must accompany your
payment to the Register of Wills. Make check
payable to: "Register of Wills, Agent".
x
x
NOTE: If tax payments are made within three
(3) months of the decedent's date of death,
you may deduct a 5% discount of the tax due.
Any inheritance tax due will become delinquent
nine (9) months after the date of death.
Tax
PART
[!] iii!!!!I~~.~iiiiii:.:.:,;""'"
[CHECK ]
ONE
BLOCK
ONLY
. The above information and tax due is correct.
1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain
a discount or avoid interest, or you may check box "A" and return this notice to the Register of
Wills and an official assessment will be issued by the PA Department of Revenue.
B. [] The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return
to be filed by the decedent's representative.
C. [] The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART ~ and/or PART ~ below.
PART
@J
TAX
LINE
RETURN - COMPUTATION OF
1- Date Established I
2. Account Balance 2
3. Percent Taxable 3
4. Amount Subject to Tax 4
5. Debts and Deductions 5
6. Amount Taxable 6
7. Tax Rate 7
8. Tax Due 8
TAX ON JOINT/TRUST ACCOUNTS
".........-......". ............................................ . .-. ..-........ .....
..._ ~" _. _. _. _........._ .... .. ... _...". "'_.".. .. 0"._....._.... ._....... ............_.......... ._. _..... ... 0" 0"._... _..... ..............- .-...-. -.. ..... ...... ........ ....,
.............-...-...................................-.............................................-...............................-...-...............................
...............................-.....................-...-.-.-.-...............................-...........-.-.-.-.....-...................................-.............
~1~~~H~~~1~1~j~j~S~1~~i~j~;l:~;i~j~~~:~~~~mi~~~1~1~!~H~m~~:~l~~~~~~~~~~~~~~!~:~;~~~~~~~;1~~~m~H~~~~:~~~~~~~~~~;1~f~~~~~~~~;~!~~~~~~~~~!~~~H~~;1!!~~~~~:~~~
...................-...-.....-.............................................................................-.............................................................
......................................................................-.....................................................................................-...........
....................................._....... ,',_,'._._._,_,_,_,_,_.-.-' ._."_'_. ........._..._._._..._._._._._..._._._._... ._......................._._.....nn .
If you indicate a different tax ratel please state your
relationship to decedent:
x
x
PART
~
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax Computation)
YI I declare that the facts I
owledge and belief.
I
$
have reported above are truel correct and
(7/7 ) 76'3 .9~6~
WORK (7/7) 76'3
TELEPHONE NUMBER
HOME
TAX
5 J I l./--'tJ..cro(
DATE
/(i' ,01// ~- J.
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
~j(*
NOTICE OF INHERITANCE TAX
APPRAISEKENTL ALLOMANCE OR DISALLOMANCE
OF DEDUCTION~I AND ASSESSKENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
REV-lS48 EX AFP 02-00l
GEORGE C SHEAFFER
1858 HOLLY DR
CAMP HILL PA 17011
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
SSN/DC
ACN
08-06-2001
SHEAFFER
01-27-2001
21 01-0277
CUMBERLAND
187-16-6564
01122467
KATHRYN
E
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE1 PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REfv:i5~i-E3f-AFP--(i1f:oO)------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 08-06-2001
ESTATE OF SHEAFFER
KATHRYN
E DATE OF DEATH 01-27-2001
COUNTY
CUMBERLAND
FILE NO. 21 01-0277
TAX RETURN WAS:
S.S/D.C. NO. 187-16-6564
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
01122467
FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICE
ACCOUNT NO.
77350251
TYPE OF ACCOUNT: () SAVINGS (x> CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 04-28-1982
Account Balance
Percent Taxable
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate
Tax Due
x
181039.07
0.166
31006.57
.00
31006.57
.15
450.99
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT1 SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS1 AGENT."
x
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
05-16-2001 AA496600 .00 450.99
TOTAL TAX CREDIT 450.99
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
* IF PAID AFTER THIS DATEI SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. *
( IF TOTAL DUE IS LESS THAN $11 NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRl1 YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. l
/(P..~/7-~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
'.'
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
.
SAMUEL LANDES
525 N 12TH ST
LEMOYNE
09-24-2001
SHEAFFER
01-27-2001
21 01-0277
CUMBERLAND
101
5~*
REV-1S47 EX AFP C12-00>
KATHRYN
E
PA 17043
Amount Remitted
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=i54j-Ex--AFP-ri"2-:0(ff-NOTlcE--OF-.rNHEiiiTAifcE-TAjrAPPRA-isEi'-ENT~--Ail-owANcE-OR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SHEAFFER KATHRYN E FILE NO. 21 01-0277 ACN 101 DATE 09-24-2001
TAX RETURN WAS:
) ACCEPTED AS FILED
SEE ATTACHED NOTICE
( X) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
98,900.00
.00
.00
.00
51,790.48
6,011.39
.00
(8)
27,550.82
NOTE: I~ an assessment was issued previously, lines 14, IS and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
.00 X 00 = .00
.00 X 045 = .00
82,598.44 X 12 = 9,911.82
44,304.90 X 15 = 6,645.73
(19)= 16,557.55
2.247.71
(11)
(12)
(13)
(14)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
156,701.87
79.79B 53
126,903.34
.00
126,903.34
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
08-13-2001 CDOOO149 .00 14,777.41
PAYMENT MUST BE MADE BY 10-27-2001~. TOTAL TAX CREDIT 14,777.41
BALANCE OF TAX DUE 1,780.14
INTEREST AND PEN. .00
TOTAL DUE 1,780.14
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "'CREDIT"' (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
REV-1470 EX (6-88)
INHERITANCE TAX
EXPLANA liON
OF CHANGES
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENTS NAME
\
FILE NUMBER
KATHRYN E. SHEAFFER
REVIEWED BY
ACN
2101-0277
101
CHARLES WRIGHT
ITEM
SCHEDULE NO.
F 2
EXPLANATION OF CHANGES
Changed tax rate from 12 percent to 15 percent since a niece, sister-in-law is a collateral
beneficiary .
ROW
Page 1
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
~REAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG I PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
"
REY-1547 EX AFP 112-00>
09-24-2001
SHEAFFER
01-27-2001
21 01-0277
CUMBERLAND
101
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
KATHRYN
E
SAMUEL LANDES
525 N 12TH ST
LEMOYNE
Amount Remitted
PA 17043
/7 xC); /4
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 --
n1rv=i54j-E:1f-AFP--(i2-::-0(ir-NCTiC~-QF-"fNHEifffANcirTAjrAppRAISEMENy-;-Ail-owAifcE-oR"-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SHEAFFER KATHRYN E FILE NO. 21 01-0277 ACN 101 DATE 09-24-2001
SEE ATTACHED NOTICE
( X) CHANGED
) ACCEPTED AS FILED
TAX RETURN WAS:
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
98,900.00
.00
.00
.00
51,790.48
6,011.39
.00
(8)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
U)
(2)
(3)
(4)
(5)
(6)
(7)
156,701.87
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
27,550.82
2.247.71
(9)
nO)
29.798 Jl3
126,903.34
.00
126,903.34
(11)
(12)
(13)
(14)
If an assessment was issued previously~ lines
~eflect figures that include the total of ALL
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate
16. Amount of Line 14 taxable at Lineal/Class A rate
17. Amount of Line 14 at Sibling rate
18. Amount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
14~ 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
NOTE:
.00 X 00 = .00
.00 X 045 = .00
82,598.44 X 12 = 9,911.82
44,304.90 X 15 = 6,645.73
(9)= 16,557.55
(5)
(6)
(7)
(8)
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
08-13-2001 CDOOO149 .00 14,777.41
PAYMENT MUST BE MADE BY 10-27-2001*. TOTAL TAX CREDIT 14,777.41
BALANCE OF TAX DUE 1,780.14
INTEREST AND PEN. .00
TOTAL DUE 1,780.14
IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
'l.EV-1470 EX (6-88)
,..
.I
INHERITANCE TAX
EXPLANATION
OF CHANGES
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENrS NAME
FILE NUMBER
KATHRYN E. SHEAFFER
REVIEWED BY
ACN
2101-0277
101
CHARLES WRIGHT
ITEM
SCHEDULE NO.
F 2
EXPLANATION OF CHANGES
Changed tax rate from 12 percent to 15 percent since a niece, sister-in-law is a collateral
beneficiary .
ORIGINAL
Page 1
/t.-c2l7- ~
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
SK ~
c.. ~
REV-I607 EX AFP (12-00)
SAMUEL LANDES
525 N 12TH ST
LEMOYNE
.01 NOV 30
of DA TE
\Nitts ESTATE OF
DATE OF DEATH
FILE NUMBER
P 3 :20 COUNTY
ACN
11-26-2001
SHEAFFER
01-27-2001
21 01-0277
CUMBERLAND
101
KATHRYN
E
ReCOfoeo
Register
PA 170erk-C ;,-;oun
C.tnnberland CO'f PA
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE~ PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-"=i6oj-Ex--AFP--ci'2:oo1-------...-INifERITANc'E--TAx--STAfEM'E-NT-OF-Accouiff--...---------------- -- ---
ESTATE OF SHEAFFER KATHRYN E FILE NO.21 01-0277 ACN 101 DATE 11-26-2001
THIS STATEHENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAHED ESTATE. SHOWN BELOW
IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYHENTS~ THE CURRENT BALANCE~ AND, IF APPLICABLE~
A PRO~ECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 09-24-2001
P R I N C I PAL TAX DUE: .......................................................................nmm..n.nn
16~557.55
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
08-13-2001 CDOOO149 .00 14~777.41
10-17-2001 CDOO0400 .00 1,780.14
TOTAL TAX CREDIT 16,557.55
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
. IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)~
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. )
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ANDES SAMUEL L
525 N 12TH ST
LEMOYNE, PA 17043
__n_n_ fold
ESTATE INFORMATION: SSN: 187-16-6564
FILE NUMBER: 21 - 2001 - 0277
DECEDENT NAME: SHEAFFER KATHRYN E
DA TE OF PAYMENT: 08/13/2001
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 01/27/2001
NO. CD 000149
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $14,777.41
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$14,777.41
REMARKS: MARY E. SHEAFFER
CHECK# 1012
SEAL
INITIALS: DO
RECEIVED BY:
REGISTER OF WILLS
MARY C. LEWIS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ANDES SAMUEL L
525 N 12TH ST
LEMOYNE, PA 17043
___n___ fold
EST A TE INFORMATION: SSN: 187-16-6564
FILE NUMBER: 21 - 2001 - 0277
DECEDENT NAME: SHEAFFER KATHRYN E
DA TE OF PAYMENT: 10/18/2001
POSTMARK DATE: 10/17/2001
COUNTY: CUMBERLAND
DATE OF DEATH: 01/27/2001
NO. CD 000400
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $1,780.14
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: ALLFIRST BANK
C/O SAMUEL LANDES
CHECK#1014
SEAL
INITIALS: SK
RECEIVED BY:
REGISTER OF WILLS
$1,780.14
MARY C. LEWIS
REGISTER OF WILLS
~ ~
-~-
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
I
GEOI'(;:~ '
(4;"
lE5U
:: Pi f.'if'
- FOLD HERE
ESTATE INFORMATION:
FILE NUMBER
.~
'>.
-
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
No.AA 4 96600 REV-1162 EX (11-96)
ACN
ASSESSMENT
CONTROL
NUMBER
/; l~ '?
NAME OF DECEDENT
S\1E "~fT ;
DATE OF PAYMENT
(MI)
2 .'~ --- -2 (",", .
E.3/1 {,i,' ;":".'i><,
POSTMARK DATE
.:~ / '1 (~)
COUNTY
C_If"Ell.:i.' .('if
DATE OF DEATH
1 I :7',i
REMARKS GL~C
SEAL;- ~i
, i
(FIRST)
TOTAL AMOUNT PAID
~ .~:
RECEIVED BY
<1/t:;I (
:<':i'::\ r,:,,"_
REGISTER OF WILLS
AMOUNT
"Il :,~~. ;, /; '~) ()
FOLD HERE
,. '?;'
i j,>'
l4~"
I.p
,," "- I...(.A' /---1. /~ ~
./ (~ /'-
,I ,(/
)(.-fi~
A,)..
"]," I.~t/...
, ~ ,C-'--j
c/
STATUS REPORT UNDER RULE 6.12
Name of Decedent: K~+hr'1N E.
Date of Death: 1- L 1- 2001
.s h-e.fA-t+e r
Will No.
Adm in. No. 21- D , - 0 Z 7 7
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1 .
State whether administration of the estate is complete:
Yes y.. No
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 X
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 X No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
gQP~
Signature
Date:
\I-l't-o\
I.i
~-- !Pi J8qUfn~
11<3r~
SA-C'V'\~€L- L. ANO€S
Name (Please type or print)
S2 5 (V~ /2 ~ :5'.f/l~e+
LtMoy#e PI1 170'1'3
Address
\-1--1 .
-{ \.1.
6S: LUf E- ::lID 10.
( 7n) ...,~, 51'"
Te 1. No.
lC~
"~.;; ;;'J8H
"- .:: i.-J:.)a~
Capacity:
Personal Representative
X Counsel for personal
representative
(MAH:rmf/AM3)
REV-1500EX(6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT 280601
HARRISBURG, PA 17128-0601
REV-1500
OFFICIAL USE ONLY
~
w
...,
::.::~(/)
u Q'"
wo.u
",00
u"'....
0.01
0.
"
.7& -~3._~_lt2___
FILE NUMBER
~.L-D..L 0'21_
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COUNTY CODE
YEAR
NUMBER
I-
Z
W
C
W
o
W
C
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SHEAFFER, Kathr n E.
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
01-27-2001 04-07-1912
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
SOCIAL SECURITY NUMBER
187 -
16
6564
~ 1. Original Return
D 4. Limited Estate
D 6. Decedent Died Testate (Mach copy afWill)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (date o/death after 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copy of Trusl)
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
D 3. Remainder Return (dale afdeath prior to 12-13-82)
D 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) {Attach Sch 0)
...,
Z
W
o
Z
o
0.
'"
W
'"
'"
o
u
NAME
COMPLETE MAILING ADDRESS
525 North 12th Street
Lemoyne, PA 17043
Samuel L. Andes
FIRM NAME (lfApplicsble)
TELEPHONE NUMBER
(717) 761-5361
1. Real Estate (Schedule A)
2. Slocks and Bonds (Schedule B)
(1) 98,900.00
(2)
(3)
(4)
(5) 51, 790 . 4 8
OFFICIAL USE ONLY
3. Closely Held Corporation, Partnership or Sole-Proprietorship
z
o
!;;:
...J
~
l-
ii:
<C
o
w
0::
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
(6) 6,011.39
(7)
(B) 156,701.87
(9) 27,550.82
(10) 2,247.71
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent. Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
(11) 29,798.53
(12) 126,903.34
(13)
(14) 126,903.34
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 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
z
o
!;:
I-
~
11.
::E
o
o
~
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
x.O_ (15)
x.O_ (16)
x .12 (17) 15,228.40
x .15 (18)
(19) 15,228.40
16. Amount of line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
126,903.34
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF MJ OVERPAYMENT
Decedent's Complete Address:
STREET ADDRESS Hollv Drive
1858
CITY Camp Hill I STATE PA I ZIP 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1) 15.228.40
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments 45 0 . 99
C. Discount
TotaICredits(A+B+C) (2) 450.99
3. InteresVPenalty if applicable
D. Interest
E. Penalty
TotallnteresVPehalty ( D + E ) (3)
4. If Line 2 is 9reater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5) 1 4 . 77 7 . 41
(5A)
(5B) 14.777.41
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
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;............ ... ........................................... ... D ~
b. retain the right to designate who shall use the property transferred or its income; ........... ......................... D ~
c. retain a reversionary interest; or.................................... . ............................................ ........................... 0 ~
d. receive the promise lor life of either payments, benefits or care? ........................ ...................................... D M
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ........ ...................................... ......................... ....... D ~
3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death? ...... . D IZI
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ...................... ................................... ............................................. D IZI
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 pe~lJry, I declare that I 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
DATE
~-\e.ol
Hill, PA 17011
13
ADDRESS
I L. Andes
N. 12th Street, Lemoyne, PA 17043
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 sUlViving spouse is 3%
[72 P.S. ~9116 (a) (1.1) (i)).
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the survivin9 spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)).
The statute does not exemot a transfer to a sUlViving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the sUlViving 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 01 the child is 0% [72 P.S. ~9116(a)(1.2)J.
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [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% [72 P.S. ~9116(a)(1.3)). A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV.'~2EX'''.7).
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
KATHRYN E. SHEAFFER
FILE NUMBER
21-01-0277
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 propertt 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 which Is jointly-owned with
right of
survivorshln must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
Single family residence at 1858 Holly Drive, Camp
Hill, Lower Allen Township, Cumberland County,
Pennsylvania.
VALUE AT DATE
OF DEATH
$98,900.00
NOTE: This property was sold shortly after
Decedent's death for a gross sale price of $98,900.0C
which is the value used for this tax return.
Attached hereto is a photocopy of the settlement
sheet from the sale of the property to confirm
that market value.
TOTAL (Also enter on line 1, Recapitulation) $ 98, 900 . 00
(If more space Is needed, Insert additional sheets of the same size)
A.Settlement Statement
8
U.S. Department of Housing
. Tvoe of loon and Urban Develoomenl OMS No. 2502-0265
L OFHA. 2. DFmHA l '9Conv. Unin5. I 6. File Number T 7. Loan Number I 8. Mortgage Insurancc Case Number
4. OVA 5. neanv. Ins. 01-247 615030808
C. Nole: a IS. I Ilgveyoll8 amen I . nspa an y ernen gen are own.
ItemslTl9rked(P.o_c.I'werepaldCUI$idI!llhe.~;llIeyweBlv;mnl\el"e""\nfOlllla\ilmpuTpCl$e5andarenollnducledlnlhlltolals.
WARNING: Ills a Clime to ~~~,makefalse Ita emsnls 10 IhIl Untied Stales on this orsnOolher slmllB, form. Penalties upon
conYicUonCllnlncludllanneandl ri$O/lmenl.Fordalallssell:T1Ue18U.S.CodllSedlon1 01 andSecUon 1010.
D. NAME OF BORROWER: THERESA M. BRENNAN and KA TIIR YN J. BRENNAN
ADDRESS:
E. NAME OF SELLER: MARY E. SHEAFFER
ADDRESS:
F. NAME OF LENDER: ABN AMRO MORTGAGE GROUP
ADDRESS:
Q. PROPERTY ADDRESS: 1858 HOLLY DRIVE, CAMP HILL, PA. 17011
TOWNSHIP OF LOWER ALLEN
H. SElTLEMENT AGENT: Central Penn Settlement Services, Inc., Telephone: 717-671-9876 Fax: 717.671-9676
PLACE OF SETILEMENT: 4309 Linglestown Road, Harrisburg, PA 17112
1. SETTLEMENT DATE: 0513012001
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. Conlractsalllsorice 98,900.00 401. Conlraclsatas rica 98,900.00
102. PersanalPronertv 402. PersonalProneth,
103. $etllemenlcha estoborrowerliI181400' 4,876.92 403
104. 404.
105 405.
Adiustments for Items oaid bv seller In advance Adlustments for items paId by seller in advance
10e. Cllvltowntaxes 406. CI'uftownlaxes
107. Caunlvt9xes 05/30/0110 12/31/01 169.46 407. Coun"'laxes 05/30/0110. 12/31/01 169.46
108, SchootTall.,,", OS/30/01\o.06/30/0t 74.12 406 SChool Taxes 05130/011006/30/01 74.12
109 Sewar\Trash A-M-J 05/30/0110 06/30/01 23.67 409. StIW8r\Trash A-M..J 05/30/011006/30/01 23.67
110. 410
111 411.
112 412.
120. GROSS AMOUNT DUE FROM BORROWER 104,044.17 420. GROSS AMOUNT DUE TO SELLER: 99,167.25
200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER
201. D"""'sltoreameslmo.nev 1,000.00 501. Excess Dennsitlsee Inslrucllonsl
202 Princioal amounl of new loan(s\ 93,950.00 502. Selt/emenlcha~estosetler Iln814oo\ 7,816.87
2lJ3. ExistJnnloanls1takansuhlacl(o 503. E:odsllnnloan~akensubiBcllo
2lJ4. 504. Pa""'ffafFlrsIMo"'1aoeLoan
205. 505 PlI""'ff of Second Mortoaoa Loan
2lJ6. 506.
207. Seller Assist 2,000.00 507. SallerAssisl 2,000.00
206. 506.
209 509
Adiustments for items unnaid bv selter ~stments for items unnald bv seller
"" CilvllowntaxBs 510. Clt"ftownlaxes
211 Coun"'laKes 511 coun"'~xes
212 $choolTa.xes 512. School Taxes
213 513.
214 514.
215. 515
216. 516.
217. 517.
218. 51&.
219. 519
220. TOTAL PAID BY/FOR BORROWER 96,950.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 9,816.87
300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER
301 Gross arTlOuntdue from borrower 'lintl 120 104,044.17 601. Gmss amoullt due 10 seller Iine420 99,167.25
302 Less amounts n:old bvllor borrow~ m-;:;e 22-0\ 96,950.00 602 Less reduction arnountdue sBllerlline 520 9,816.87
303. CASH FROM BORROWER 7,094.17 6(}'. CASH TO SELLER 89,350.38
SUBSTITUTE FORM tQ99. SELLER STI>.TEMEtH: The IrdCliTOll\\oo COTlUI\n!:dhereln \s \~nllaxln!onnaUonand Is being furnished 10 the IIllernal Rewmue Service. Ifyoo are required to file
a relum.
:n~"fo~=V~~I~~~~~p<:~n;rIhS:dt::'~I::'lsltemls",qUltedIOlulreportedandthelRSdet",mlnes Ihal II has nol been reported. The ConlraclSllIIlS Prlcedescnbed on
~':elf:-~~~~G~:~rt~~F~~~~~~~r:.a~I~~~I~ebr1~:.",orrr;lJo\~.SaleorExdolnQllolP~~,lore.n~wain.wilh'f'l\ll klcmn&1a>.,oo\Ilm;lorvlh"'lranaacllons.
~~::.r:x~/~re~b~gio~~,tt;~eI~~~~r~~T~X~~,~~: Ur>derperllllUesOlP~~'::r:i".torJ:,?t~:~r:;~~t=~nt~I~~~S~~:~:~;"'~::"".:':H1~~~~:b:cation
'"
SELLER(SlSIGNATURE(S);
SELLER(S) NEW MAILING AODRESS:
TitleExpressSettlernenlSystem Pnnted0512S12001 8t16:11
REV. HUD-l (3186)
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
SETTLEMENT STATEMENT
File Number: 0]-247
PAGE 2
L SETTLEMENT CHARGES PAID FROM PAID FROM
700. TOTAL SAlESIBROKER'S COMMISSION based on orlce$95,9CC .00 . 6.000 - 5,934.00 BORROWER'S SELLER'S
DivislOll of commission IlIne 700 as follows: FUNDS AT FUNDS AT
701. I 2,992.00 10 Jack Gaughen, ERA SETTLEMENT SETTLEMENT
702. I 2,942.00 " CD HamesaIe Services Group, Inc. ,
703. Commission paid at Settlement 5,934.00
BOO. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. loanOri Ina~onFee 1.000 %Homes&le Mortgage Services, Inc. 939.50
802. loan Discounl %
803. Appraisal Fee 10 Homesale Mortgage Services, Inc. 275.00
804, CreditReoort (0 Homesale Mortga.ge. Se:rv:!..ces, "Inc. J.OO.OO
805. Pl'OCBssinnFee '" Hamesale Mortgage Services, Inc. 65.00
8'" Lender MminFee 10 ABN AMRO MORTGAGE GROUP LR 375.QO
807. Ta)(ServiceFee
808. DefPremiumpdb ABN AMRO (0 Homesale Mortgage Services, Inc'P.O.C.) 587.19 Buyer
809. Flood Ce(tjf)ca~on (0 Homesale Mortgage Services, Inc. .21.50
810.
a1'.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From 05/30/2001 to 06/01/2001 @I :l.B.2700 ,,~ 2 Days LR 36.54
902. Mortoeoe Insurance Premium for '"
903. Hazard Insurance Premium for to State Farul (P.O.C.) 293.00 Buyer
804.
905.
1000. RESERVES DEPOSITED WITH LENDER FOR
1001 Hazard Insurance 3 mo. tflJ $ 24.42 I~ LR 73.26
100Z. Martmae (nsurance mo.tflo$ Imo
1003. CllvPronertvTa)(6S mo.@$ 1m'
1004 CountvProper\vTaxes 4 mo. tflo $ 23.87 I~ Lll 95.48
1005. $chOQITIl)(eS 12 mo.@$ 69.10 Imo LR 829.20
1009. Annra Ie Ana"" is Ad ustmenl '0 ABN AMRO MORTGAGE GROUP LR 168.81-
1100. TITLE CHARGES
1101 $ettlement or dosino fee
~102 Abs\mcl. or \ille search
1103 Tillee)(emlnation
1104 Titleinsufancebinder
1105. Document Preparation (0 Samuel Andes, Bsq. 75.00
1108. NolarvFees '" Cash 14.00
1107. Attome sflles
includes above ilems No: ,
'108. Tltle]nsurance ~ Central Penn Settlement Services, Inc. 822.75
fincludesaboveilemsNo: 1101,1102,1103,1104 ,
1109. Lender'sCo>leraoe$ 93,950.00 -
1110. Owner'sCoveraQfl$ 98,900.00 - 822.75
1111. t::ND100 300,8.1 '" Central Penn Settlement Services, Inc. ~50.{lO
1112. Wire Fee to CPSS 10.00
1113. E)(PfassFee to CPSS 15.50
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recordin Fees Deed $ 27.50 ;Mortna a$ 67.50 ; Release $ 95.00
12112. C\\vICOUfllv\ax1s\amos Oeed$989.CC . Mortaaae$ 989.00
1203. $tateTexlstam s Deed$989.00 . Mortnelle $ 989.00
1204 Assirlflmtlnl b Recorder of Deeds 14.00
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. $urvev
1302 Pasllnsnecllon 10 Homecheck POC
>3'" HomeWllrran '0 .Jack Gaughen, ERA 365.00
1304. Transac~on Fetl 10 Jack Gaughen, ER. 100.00
1305, 2001 CMTwn Ta~e& \0. Mary bn Prior, Trei!l.su.rer 286.37
1306. Homelnspec~on '" HOIIIeChek POC
1307. Transac~on Fee '0 CB Hamesale Services Group, Inc. . 1.'2.5.00
1308. Sewer and Trash (0 Lower Allen Township Authority 67.50
1400. TOT At SETILEMENT CHARGES lenter on lines 103, Section J and 502, Sec~on K\ 4,871;'92 7,816.87
HUO CERTIFICATION OF BUYER AND SELLER
~n~:~n~r..:,,~=:~~~~~~e"::;~~~~:~I~:'::~~\OJe~Je~";;':~~t~~:.rellel. It IS S tr1J& aod SCCUf8te etalem&nt 01 "lIl"tlCeipls snd diaburssm&nls made on my-=>unt or by mil
'"'~':tn &~&.-n ./
202427268
~'~Arl~
I . 1'11'01'1
19260954
JJ2.~J. ~ycifr, fXe.C,,-+f;X J'V
192145705 e.s.1:~
WARNING: IT IS A CRIME TO KNOWiN~L Y MAKE FAlSE STATEMEIons TO TI';E
\IN\TEO STAlES ON lHlS OR ANY SIMILAR FORM, PENALTIES UPON CONVICTION
CAN INCLUDE A fiNE ANO IMPRISONMENT. FOR DETAILS SEE TiTLE 16:
U.S,COOESECTlON1001ANDSECTION1010.
By:
TitleExpress Settlement System Printed 051251200] aI16:] I
REV. HUD-l (J/86)
,,y.,..,,,.,,.,,.
COMMONWEAlTH OF PENNSYLVANIA
INHERJTANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
KATHRYN E. SHEAFFER
FILE NUMBER
21-01-0277
Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jolntly.owned wtth the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
1.
Certificate of Deposit No. 80000002183808 with Allfirst Bank
See letter from bank attached
$25,134.83
2.
Certificate of Deposit No. 87008101103538 with Allfirst Bank
See letter from bank attached
$12,515.16
3.
Certificate of Deposit No. 87008140105273 with Allfirst Bank
See letter from bank attached
$13,047.49
NOTE: The decedent had a safe deposit box with Allfirst Bank.
The safe deposit box was opened and inventoried after the Decedent's
death, and was found to be empty and had no contents. Attached
hereto is a copy of the safe deposit box inventory (Form REV. 485Ex)
to confirm that information.
4. Refund from CGU Insurance on homeowner's insurance policy $93.00
5. Household furnishings, clothing, and other items of personal property
(value estimated only) $1,000.00
TOTAL (Also enteron line 5, Recapitulation) $ 51,790.48
(If more space is needed, insert additional sheets of the same size)
06/19/01
~1 302 934 2955
CIS
09:19
Samuel L. Andes
Attorneys At Law
525 North Twelfth Street
PO Box 168
Lemoyne, PA 17043
Re: Estate of Kathrvn E. Sheaffer
Social Security: 187-16-6564
Date of Death: Januarv 27. 2001
Dear Sir or Madam:
./1'
Allfirst Financial Center N.A
PO Box 900
Millboro, DE 19966
March 29,2001
~ 003/004
allfirst
Per your inquiry dated March 21, 2001 please be advised that at the time of death, the above..named decedent had
on deposit with this bank the following:
L
Type of Account
Relationship Chg W/lnt
Account Number
0077350251
Ownership (Names of)
Kathryn E. Sheaffer
George C. Sheaffer
Mary E. Sheaffer
04/28/82
Opening Date
Balance on Date of Death
$18,034.17
Accrued Interest
$ 4.90
Total
$18.039.07
2.
Type of Account
Certificare of Deposit
Account Number
80000002183808
Ownership (Names of)
Kathryn E. Sheaffer
08/29/00
Opening Date
Baiance on Date of Death
$25,000.00
Accrued Interest
$ 134.83
Total
---$25,"j J:{sJ---------------------
06119/01
09:19
~1 302 934 2955
CIS
I4J 004/004
3.
TYpe of Account
Certificate of Deposit
Account Number
87008101103538
Ownership (Names of)
Kathryn E. Sheaffer
Mary E. Sheaffer.POA
06/14/82
Opening Date
Balance on Date of Death
$12,495.16
Total
$ 20.00
.--$72:51516--------
Accrued Interest
4.
TYpe of Account
Certificate of Deposit
Account Number
87008140205273
Ownership (Names of)
Kathryn E. Sheaffer
Mary E. Sheaffer,POA
04/08/96
Opening Date
Balance on Date of Death
$13,000.00
$ 47.49
Accrued Interest
Total
n'$T3,04'f'49
5.
Type of Account
Safe Deposit Box
Account Number
1000535100002943
Opening Date
Kathryn E. Sheaffer
Mary E. SheajJer,POA
11/13/98
Ownership (Names of)
These accounts were convertedfrom the acquisition of another financial institution. U1ifortunately,
we are unable to access any in/armarian pertaining to the date the account was made joint
This letter does not include any accounts in which the deceased may Iu1ve been listed as Power of Attorney,
Custodian of Uniform Transfers, Representative Payee, or Trustee under a Written Agreement.
For further account informaticm, closures and/or reimbursement a/funds refer to below branch:
HIGHLAND PARK OFFICE
344 sourn 10" STREET
LEMOYNE, P A 17043
717.737-3322
~~
Assistant III
Cis Services, (302) 934-2909
REV_4BSEX+(1.921
~ij-
SAFE DEPOSIT BOX
INVENTORY
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
OEPT.280601
HARRISBURG. PA 17128.0601
Please Print ~r Type
MUST BE COMPLETED BY REPRESENTATIVE OF FINANCIAL INSTITUTION WHERE SAFE DEPOSIT BOX IS LOCATED AND RETURNED TO ABOVE ADDRESS
COUNTY CODE FILE NUMBER SOCIAL SECURITY OR DEATH CERTIFICATE NUMBER
{'fj' 7, Ib . &5"""6 'f:
DATE OF DEATH
7, Q/.
(S~!-
/7<71/1
(CITY} ."",STATE)
c..e /1-1"-{ ,,'" I Yl
DATE AND TIME OF LAST ENTRY
1.'iJ 'Ct
TITlE UNDER WHICH BOX IS REGISTERED
I</}TIf/lY-V E. /, Ct'7Frr/?
DECEDENT'S NAME (LAST, FIRST, MIDDLE)
.5'1/ ~
ADDRESS OF DECEDENT (STREET) (CITYI /?
/1!SY /lcc.<..y (JI/. CI?41' /IILI.-
NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX
(NAME)
E
111/-11<Y e ~fI elJ Frn1.
(STREET ADDRESS)
7'0) Ll S'{JC/1111/ hI'?
(CITYI
CI9M~ Iltc..c.
NAME, ADDRESS AND RELATIONSHIP (IF ANY) TO DECEDENT. OF PERSON(S) PRESENT AT THE BOX OPENING
a. (NAME) (RELATIONSHIP)
/11/9/lY E 511/Y)Fj=,-y( "5'5'TP/l IfV' L~VV'.
(STREET ADDRESS) JCITY)
qc>~ L.l 5'1:JC/JI/V /Jr.J Cl9m~ IYILL
b. (NAME}
(RELATIONSHIP}
(STREET ADDRESS)
(CITYI
c. (NAME)
(RELATIONSHIP)
(STREET ADDRESS)
(ClTYI
NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED
(NAMEI
f)LL ftt1 1'1 /Jl1tvt<
(STREET ADDRESS)
to.,./! .I. L.ov-7'1/"(1
I NAME OF PERSON MAKING LAST ENTRY
/J"J/J/?j C l/T';/:fA-fP~/Z
DATE Of CONTRACTTO RENT BOX NUMBER Of BOX
.JS. qc; c-. '-I
NAME AND ADDRESS Of PERSON IS) HAVING ACCESS TO BOX
a. {NAMEI
b. (NAME)
.-
-
(STREET ADDRESS)
(STREET ADDRESSI
(CITYl
(STATEI
(ZIP CODE) (CITY)
NAME AND TITLE OF EMPLOYE TAKING THE INVENTORY
;11,c:4.
717. 7<f'3 -1Cf-q5':
,/Jfi;/J
~ If Y." a. Date of will:
b. Nam. and addre.. of personal r.pr...ntutive, if named In the will
(NAME)
(STREET ADDRESS)
(CITY)
c. Name and addr... of attorney, if any
(NAME)
(STREET ADDRESS)
lCITYI
(STATE)
;?/l
).STATE)
I/}:/
(STATE)
(STATE)
(STATE)
(STATE)
(STATE)
(ZIP CODE)
I1'=' /1.
(ZIP CODE)
( /C'I/.
(ZIP CODE)
/7C'11
(ZIP CODE)
(ZIP CODE)
(ZIP CODE)
I 7<<fS
(ZrpCODE)
(ZIP CODE)
(ZIPCODEJ
Pege__ _____ of
SAFE DEPOSIT BOX INVENTORY
INSTRUCTIONL__
(1 J Cash: Report total only_
(2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are
to be designated by name of company, certificate number, date of certificate, name in which stock is regisfered,
cmd number of shares and dass of stock.
l
I
(3) Obligations of U. S. Government: Number of items, date of issue, face value, names in which registered
and type of ownership, i.e., jointly held, payable on death, etc.
(4) Bonds: Designate by nome, amount, serial number, or other designation. (Bearer Bonds)
(S) Bank and Savings and Loan Passbooks: State nome of depositor, number of book, last date appearing in
book, name of bank and branch, and balance.
(6) Jewelry, Coins, Stomps, Manuscripts, ete: List and describe as fully as possible.
I (7) Deeds, Mortgages, Current Insurcmce Policies or other evidences of indebtedness: List and describe as
fully as possible.
(8) All other contents.
ITEM ITEM DESCRIPTION
NO.
/I/O c-o/VTrrvTS. c eM!''! y 7..
I
I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD 1$ PERSON RECEIVING COPY OF
CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF. SAFE DEPOSIT 1l0X INVENTORY,
S'GNATUR~ /") .... --z.----- SIGNATURE E oRed //K ,
~ ~ .'1-
PRINT NAME PRI T NAWiE AND CHECK AI'PJIDPRIATE SOX BELOW:
T/lC"'lM!'JS' IJ 1I=A-/7
PRINTTtTlE CHECK APPROPRIATE BOX:
I1CC/} ~Executorltrjxl OAdministrator(trix)
o Estate Representative 0 Joint owner of safe deposit box
NOTE: Allach additional BV," x II" sheet (s)lf necessary ar use duplicates af this page af farm.
REY-1509 EX+ (12_88)
'*
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
KATHRYN E. SHEAFFER
FILE NUMBER
21-01-0277
ESTATE OF
Joint tenc:mt(s):
NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A.
George C. Sheaffer
340 North Front Street
Wom1eysburg, PA 17043
Brother
B.
Mary E. Sheaffer
903 Lisburn Road
Camp Hill, PA 17011
C.
Joi"tly~owned property:
LETTER DATE
ITEM FOR TOTAL VALUE DECD'S DOLLAR VALUE OF
NUMBU JOINT MADE DESCRIPTION OF PROPERTY OF ASSET % INT. DECEDENT'S INTEREST
TENANT JOINT
l. A,B 28 May Checking Account No.
1982 0077350251 with A11first Bank $18,034.17 1/3 1$6,011.39
I
TOTAL IAlso enter on line 6, Recapitulation) S 6 011.39
(If more space is needed insert additional sheets of same size)
REV.1511EX + (1.97)
'*
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
KATHRYN E. SHEAFFER
FILE NUMBER
21-01-0277
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
I. Myers-Harner Funeral Hone, rnc.
1903 Market Street, Camp Hill, PA 17011
(funeral services, see statement attached) $6,190.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions $5,000.00
Name of Personal Representative (s) Marv E. Sheaffer
Sodal Securily Numbe~s) I EIN Number of Personal Representative(s)
Street Address 903 Lisburn Road
City Camp Hill State PA Zip 17011
Year(s) Commission Paid: 2001
2. Attorney Fees Samuel L. Andes $4,000.00
3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant N/A $0.00
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Register of Wills ($229.00) $381.63
Estate AdvertislWl <(52'f3)
A fa f F Register 0 11 s ( iIing fee) $15.00
5. ccoun n s ees $0.00
N/A
6. Tax Return Preparer's Fees N/A $0.00
7. SEE A'ITACHEJ) SHEEr $11,964.19
TOTAL (Also enter on line 9, Recapitulation) $ 27,550.82
(If more space is needed, insert additional sheets of the same size)
SCHEDULE H - FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
ESTATE OF KATHRYN E. SHEAFFER
21-01-0277
7. Costs incurred and paid to maintain real estate following death of decedent:
UGI - gas service $722.76
PAWC -water service $80.21
PP&L - electric service $83.55
Lower Allen Twp. - refuse collection bills $67.50
Mary Ann Prior - tax collector (2001 real estate taxes) $296.17
Wayne Noss - labor to paint house $226.00
Aetna Electric - electrical repairs $800.00
Gingrich's Plumbing & Heating - bathroom repairs $95.00
Bower's Pest Control - termite inspection $30.00
Additional Burial expenses:
Eberly Mills Church - post-funeral luncheon
$100.00
Settlement costs on sale of residence:
NOTE: See settlement sheet from the sale of the
residence to confirm the following expenses:
Jack Gaughen ERA and Home Sale Services Group,
Inc. - real estate commission
Samuel L. Andes - deed preparation
Realty transfer tax
Jack Gaughen ERA - home warranty fee
Jack Gaughen ERA - transaction fee
Teresa M. Brennan - "seller's assistance" to purchaser
$5,934.00
$75.00
$989.00
$365.00
$100.00
$2.000.00
Total for Item 7
$11,964.19
I'"
",."",,.,..,,'*.
OOMMO/'iwEAIYU or r(NNSnw.NIA
IN"fIlIJA",CE" TAll ItflUII.N
IIUIDEN, D[clDU~1
[STAlE OF
SCIiEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES AND LIENS
KATHRYN E. SHEAFFER
PI. as. Print or Type
i FilE NUMBER
21--01-277
ITEM. DESCRIPTION AMOUNT
NUMBI;R
1.
1. Verizon - telephone service (less refund received) $62.21
2. Comcast - cable service $60.50 ,
3. Church of God Nursing home - final bill $1,267.20
4. West Shore Emergency Medical Services $87.75
5. HealthSouth Rehab Hospital - medical treatment $100.00
6. Physicians of Rehabilitation, Industrial and
Spine Medicine, P.C. - medical treatment $198.58
7. Internists of Central Pa. - medical treatment $142.45
8. Moffitt Peace & Lim - medical treatment $158.99
9. Carlisle Hospital - medical treatment $5.89
10. ASSRciated Cardiologists - medical treatment $1.21
11. Neurblogical Surgeons Associates - medical treatment $53.06
12. Brockie Philrinatech - medications $109.87
I
- --._--
TOTAL (Also .nlar on line 10, Rccopilulotiofll S 2,247.71
"(If marlt ~pOCD is noedod, in~.rI od,}ilimu;,' .shooh; of sam. sizo.}
""'.,,""'.,'.,'.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
KATHRYN E. SHEAFFER
NUMBER
I.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1. George C. Sheaffer
340 N. Front Street, wonn1eysburg, PA 17043
2 . Barbara S. Bourdette
15 Cedarhurst Lane, Camp Hill, PA 17011
3 . Donna Whitsell
6220 Black Hill Road, LocH, WI 53555
4.
Diane Roddy
2577 Valley Road, Marysville, PA 17053
5.
Debra Enders
1070 CEmetary Road, Marysville, FA 17053
FILE NUMBER
21-01-0277
RELATIONSHIP TO DECEDENT
Do Not lilt Trustee(l)
AMOUNT OR SHARE
OF ESTATE
brother one-third
niece one-third
niece one-ninth
niece one-ninth
niece one-ninth
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL OISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
NONE
II.
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. NONE
TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ 0.00
(If more space Is needed, insert additional sheets of the same size)