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Home My WebLink About01-0857 ~RITlON FOR PROBATE. and GRAN.T OF LETTERS Estate ofWP /YJaO'r> c:J, .s4u)j(A. No. .;)/-01 -?:.5J also known as To: Register of ~ls fpr_ th,._ J. .I}fgeas~. County of ~L~ In the Social Security No. /9,;( - ~c?.:. qy~ 7 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an thel execut in the last will of the above decedent, dated oJ u _ y /9 and codicil(s) dated .:R/x named j' ,%-010) Decendent was domiciled at death in h <e" last fami r principal re . t{ (list street, number and mun ' ality) Decenden . Yl'ars of age, died ~ ~/ ~ of~ I, at Q.. Except as folIo s, 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: 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 situated as follows: g~~ / $ $ $ $ - <Il tl (.) t:: ~ "0 - ._ <Il <Il_ ~ .... o::~ -g.g a:s-.c 3~ ~...... ~o Cd t:: Clll en ])E&?h".AAI /iI%~M/1 fU0z1:4~J7CNs- C.La.; administration d.b.n.c.La.) WHEREFORE, petitioner(s) respectfully presented herewith and the grant of letters theron. jJ~c/~ p~~ OATH OF" PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA I ss COUNTY OF~ _ (~UMBERIND J The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will weUnd ~ruly administer the estate according to law. Sworn to or affirmed and subscribed { ~d/ ~ ;y ~~ ~ before me this 17th day of - ~ ~F~ WQ.QO.L a - rr)CLU1 - - ~~~B.~ Register ~ 17 ~ -'] . ~ No. 21-01-857 Estate of ROSE MARIE G. SHUIDA , Deceased DECREE OF PROBATE AND GRANT OF LETTERS and Letters are hereby granted to AND NOW SEPrEMBER 18 1~2001, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated JULY 19 I 2001 described therein be admitted to probate and filed of record as the last will of ROSE MARIE G. SHULDA TESTAMENTARY DEBORAH ANN NICHOLL ?-rj().....( c. ~ f:' /)B~.:\--: J Register of ills \ FEES $ 200.00 $ 9 00 $ $ 15.00 ~.uu TOTAL _ $ ??q 00 Filed ........ SEPTEMBER.1.a,,20Dl.. . ... Probate, Letters, Etc. ......... Short Certificates( ).......... Renunciation ................ x-pages JCP AITORNEY (Sup. Ct. 1.0. No.) ADDRESS PHONE ~ t>?aJJ 6, ~ J10C;:.~0C::; ~~V Olt'/'., This is to certify that the information here given is correctl co . d fi . . ' Local Registrar. The original certificate will be fj d d y h plSe ro~ an ongmal certificate of death duly filed with orwar e to t e tate Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph" 21-01-857 Fee for this certificate, $2.00 p 7622094 No. me as -..,. ~ ~t:.r 11 l001 Date 2/17 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH NAME 01' DECEDENT (hst. M_. 1.._1 SEX 1. Rose UNOER , YEAR Monltla Daya BIRT....LACE (Coly and SIaNI or f c<eogn Cauna'll DECEDENT'S USUAl OCCUPRlON -- ~-=:.;r'-"=::~~ ,,?1St.aner service rep 1~ications DECEDENT'S MAILING AOOfleSS (SIr....~. SlML Zip Codel DECEDENT'S 6 Westwood Court :r::-NCE ~ ,..Enola, PA 17025 ""__I RIJHEft.s NAME (Fw.. Miclde. Lalli Cannen CUmbo '1.. SIaIe Did ........ .... in . -....7 Cumberland co. nit. 11. INFOAUANT"S NAME (TypeIPrinl) Deborah A. Nicholl Jt1 .......24-21_ be lCIlII'ftIIIaIad by ...-.no..--- ....... 24- ~ 11. PAIn' I: e_............ injuries 01 CillIftClIicaliona wIliclI__'''' de..h. 00 not.......... mode 01 <lying. .uch.. c.rdiaco"eljlitalOtY .It.... _ 01"''''' '.iIu,.. LiIr 0llIV- _on MCh line. -...1E CAUN (F1llIII _ or c:ondiion _ t-*'lI '" CINIh)- r'c.c I? M~"'a' .57'/1'7/t:. L-U.JJ c:; c.. DUE 10 lOR AS A CONSEQUENCE OF}: =~..---- =..... -....g to ........... =_.e-~ :; CAUN co-- or -..rY =...--- ~'eUIIng '" 0.111 LAST lb. c. d. DUE 10 lOR AS A CONSEOUENCE OF): DUE 10 COA AS A CONSEQUENCE OF): =~~AU1OPSV WERE AU10PSV FlNOINGS MAHHER OF DEAI'H OATE OF INJURV ~PEAFOAMED7 .uIlA8LE PflIOA 10 CMonlh. 0lIv. ...., COUP\.ET1ON OfF CAUSE ~ - OF Dl!RH7 .......... Hom_ O - Mcidefll 0 Pendingl~lon 0 - D No ~D No 0 Suicide 0 Could naI be dalan'l111leC1 0 21. ~ 2Ib. c:sn.... \Ctl<<* only one) "C8ITWYlNG 1'HYSlC1AN\""Y$ID8l'~~'" dealh _ _Ilhvsoc....."'" pr~dealll ana complalad 11em 231 To........o1l1lYlI.........dell1hOCC__......cauM(.land_...-.................................................... . ~i · .PROtOJNCINQ ANDCERTIFYINO PtftStC......tPhys&;liJnbolh pI~dea&h .-dc""'y.ng 10 cause of dealt\l To..._oflllYlI.............Ih__.,..._. ......_plec.. andd...lo...c_C.\.ndm.nn.'................................... ~ : "1IEDlCAL U"....AlCORONIER On the buIa of ..amlna'l_ and/or In....,l9atiOn.1n my opinion. death occurred a'the dIM. dat.. and pl.ce. and due '0 !he c.....(.} and ...- a. ata'ed.. . . . . . . . . . . . . . . . . . . . . - . . . . . . . . . .. . . . . . . . . . . . .. . . . . . . . . . . .. . . . .. . . .. . .. . .. . . . . . . . . . . . . .. . . . .. . . . .. :n.. REGIST~.SlGNAI'URE AND NUM~ . . ,,_ ",,, m r? 4'.A.-1.,~.r'/P--ttI? 12--""" b2 /10{.;1 II 3.iJ (/ , :=dVID MARITAl STAlUS . Married N_ Marriacl. W_. ~-' lSPedYI 1.4i vorced t7c)( '1M. deC8lIan1..... .fast RACE. Amancan Indian.lIlack, WhiI.. ale. (Speedyl 1o~ite SURVIVING SPOUSE (N _. gova """'*' namal ...... eily/tIorQ. PART .: TIME 01' INJURY INJURV AI' WOAI<7 DESCRIBE HOW INJURY OCCUMED. _ 0 NoD . Day. "'--I A!.tI /f ?' o :N. (')~I Scott M. Dinner Attorney at Law 3117 Chestnut Street CaDlp Hill, P A 17011 tel: (717) 761-5800 fax: (717) 761-5008 LAST WILL OF ROSE MARIE G. SHULDA I, ROSE MARIE G. SHULDA, presently of 6 Westwood Court, Enola, Cumberland County, Pennsylvania, declare this to be my Last Will hereby revoking all Wills and Codicils previously made by me. I declare I have four children born to me and now living: Deborah Ann Nicholl nee Shulda, born May 30, 1960, Ronald L. Shulda, Jr., born July 17, 1962, Beverly Ann Lafever nee Shulda, born March 23, 1964, and Tammy Ann Danner nee Shulda, born May 9, 1965. All references in this Will to 'my children' include only those four individuals named above. ARTICLE I Payment of DebtslExpenses: I direct the payment of my debts, including the expenses of my last illness and funeral, from my estate as soon after my death as conveniently may be done. ARTICLE II Personal Property and Household Effects: I give certain items of my household furnishings and tangible personal property to my friends and family in accordance with the terms of Scott M. Dinner Attorney at Law 3117 Chestnut Street Camp HiU, PA 17011 tel: (717) 761-5800 f_: (717) 761.5008 -2- a written memorandum which I have prepared. I bequeath any such property not disposed of by such memorandum, or all of such property if the memorandum is not located or received by my Personal Representative, to my children who survive me to be divided among them by my Personal Representative (with due regard for their personal preferences) in as nearly equal shares as practical. If the written memorandum referred to in this ARTICLE II is not located or received by my Personal Representative within sixty (60) days after taking office as such, after and upon the conducting of a reasonable search for such memorandum, the Personal Representative shall be held harmless for distributing such property as hereinbefore provided. ARTICLE III Residuary Estate: I do give and bequeath the rest, residue and remainder of my estate, both real, personal and mixed, of whatsoever kind and wheresoever situate equally to my children who survivie me, per capita. ARTICLE IV Personal Representative: I nominate and appoint my daughter, Deborah Ann Nicholl, to serve as Personal Representative of this Will. In the event of the death, resignation, renunciation or inability to act of my daughter, Deborah Ann Nicholl, then I appoint my son, Ronald L. Shulda, Jr., as my successor Personal Representative of this Will in her place and stead. Scott M. Dinner Attorney At LAW 3117 Chestnut Stn:et CAmp Hill. P A 17011 tel: (717) 761-5800 faa: (717) 761-5008 -3- ARTICLE V Fiduciary's Performance and Powers: No fiduciary under this will shall be required to give bond or other security for the faithful performance of the fiduciary's duties. Any such fiduciary shall have the following powers, in addition to those given by law: 1. To retain any property, pending distribution hereunder, to invest in or purchase any property without restriction to legal investments for fiduciaries (except for those fiduciaries subject to the Pennsylvania Prudent Investor Act), to distribute property in kind, to disclaim any interest in property, and to sell any property at public or private sale; 2. To hold shares of stock or other securities in nominee registration form, including that of a clearing corporation or depository, or in book entry form or unregistered or in such other form as will pass by delivery; 3. To engage in litigation and compromise, arbitrate or abandon claims; 4. To make distributions in cash, or in kind at current values, or partly in each, allocating specific assets to particular distributee on a non-prorata basis, and for such purposes to make reasonable determinations of current values; 5. To make elections, decisions, concessions and settlements in connection with all income, estate, inheritance, gift or other tax returns and the payment of such taxes, without obligation to adjust the distributive share of income or principal of a any person affected thereby; 6. To borrow money from any person including any fiduciary acting hereunder, and to mortgage or pledge any real or personal property; 7. To manage, control, repair and improve all estate property; 8. To procure and carry at the expense of the Estate, insurance of the kinds, forms and amounts deemed advisable by my Personal representative to protect the Estate against any hazard; 9. To employ any attorney; investment adviser, accountant, broker, tax specialist or any other agent deemed necessary in the discretion of my Personal Representative and/or my Trustee; and to pay from my estate and/or the Trust estate reasonable compensation for all services performed by any of them. Scott M. Dinner Attorney at Law 3117 Chestnut Street Camp Hill, PA 17011 tel: (717) 761.5800 flU: (717) 761.5008 -4- ARTICLE VI Death Taxes: I direct that all inheritance, estate, transfer, succession and death taxes, of any kind whatsoever, other than any generation skipping taxes, (including any interest and Penalties thereon), which may be payable by reason of my death with resPect to: (i) proPerty passing under this Will or (ii) any of my nonprobate property, shall be paid out of the property giving rise to such taxes on an incremental tax basis. ARTICLE VII Protection from Improvidence: No interest of any beneficiary under this Will or any codicil hereto shall be subject to anticipation or voluntary or involuntary alienation. ARTICLE VIII Invalidity: If any provision of this Will or of any codicil hereto is held to be inoperative, invalid or illegal, it is my intention that all of the remaining hereof shall continue to be fully operative and effective so far as it is possible and reasonable. Scott M. Dinner Attorney at Law 3117 Chestnut Street Camp Hill, PA 17011 tel: (717) 761.5800 flU: (717) 761.5008 -5- IN WITNESS WHEREOF, I have subscribed hereunto and caused this my Last Will, consisting of six (6) typewritten pages, including this attestation clause, to be executed, declared and published this 19th day of July, 2001, at Enola, Pennsylvania. Witnesses: ~~t~~ ROSE MARIE G. HULDA H:J2 I .-:r3d1 . .. ... d <A-(> / .. ~~Q ,/ Residing at 771 Carriage Lane Mechanicsburg, PA 17050 ~~.~ ( '\ ' ~!tJlf/JJ~~VJ ~I Residing at 111 Sholly Drive Mechanicsburg, PA 17055 111 Sholly Drive Residing at Mechanicsburg, PA 17055 Scott M. Dinner Attorney at Law 3117 Chestnut Street c'unp HiD. PA 17011 tel: (717) 761-5800 C&><: (717) 761-5008 -6- ACKNOWLEDGMENT AND AFFIDAVIT COMMONWEAL TH OF PENNSYLVANIA) COUNTY OF CUMBERLAND ) We, Rose Marie G. Shulda, H. Robert Belche, Pamela J. Dinner, and Scott M. Dinner, the Testatrix and the witnesses, respectively, whose names are signed to the foregoing instrument, being duly qualified according to law, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will, that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, that each of the witnesses, in the presence and hearing of the Testatrix signed the Will as witnesses and that to the best of the witnesses' knowledge, the Testatrix was at the time eighteen or more years of age, of sound mind and under no constraint or undue influence. Rose Marie G. Shulda, Testatrix Witnesses: ~deuCc!?d{l~ ~~ ~< ~ F'Jy;V1~~ l On this, the ~~ay of July, 2001, before me, Dawn M. Boyer, the undersigned officer, personally appeared Scott M. Dinner, Esquire, known to me to be a member of the Bar of the Supreme Court of Pennsylvania, and certified that he was personally present when the foregoing Acknowledgment and Affidavit was signed by the Testatrix and witnesses. ~~~~ Notary Public \ ,=_;-,,_".0.>. ,,,,,_.;,~",',-, .-, -J\<-.- .~; ,..........-" hlotarial Seal Dawn M. Boyer, Notary Public Lower Allen Twp., Cl.:'mberland County My Commission Expires Dec. 15, 2001 Member. Pennsylvania Association at NcUries ./ Y CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Rose Marie G. Shulda Date of Death: 9/2/01 Will No. 21-01-857 Admin. No. To the Register: I certify that notice of (beneficial interest) estate administration 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 /0/ d .)"/0 I : v ,. , Name Address Ronald L. Sh~lda, Jr. 614 N. Front street Wormleysburg, PA 17043 Beverly Ann Lafever 1925 Chatham Drive Camp Hill~ PA 17011 Tammy Ann Danner IJ; 1/ /d~~;f4 ~/-<~~ ':d /7~9 v' Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: /~/C::;~M/ j)~~d~ iZ->? 7~~ Signature ./ Name Deborah Ann Nicholl Address 19 Citadel Drive Camp Hill"Pennsylvania 17011 Telephone (71 ~ 7 6 1 - 4 51 9 Capacity: ~ Personal Representative _Counsel for personal representative \-. /~-~-? BUREAU Of INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG# PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE Of INHERITANCE TAX APPRAISEMENT~ ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT Of TAX SCOTT M DINNER ESQ 3117 CHESTNUT ST CAMP HILL "02 DATE ESTATE OF DATE OF DEATH FILE NUMBER ":? COUNTY _1 ACN 08-26-2002 SHULDA 09-02-2001 21 01-0857 CUMBERLAND 101 '* REV-1547 EX AFP (01-02) ROSEMARIE Allount Rellitted PA 170J1 (" '\ :~. 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 ~ RE"V: iS4-j-i'X-AFP--(' lff:oz'r-NOYici--OF-INHER-iTAN-ci-Y AX-APPRAisii'-ENT~--AiroWAN-CE-OR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF SHULDA ROSEMARIE FILE NO. 21 01-0857 ACN 101 DATE 08-26-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED If an assessment was issued previously, lines 14, 15 and'or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. Allount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due TAX CREDITS: 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/Hlsc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule f) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) 114,000.00 8,431.72 .00 .00 13,448.35 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Hortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/GoverRllental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 8~149.01 75.148.78 Ul) (2) (3) (4) NOTE: .00 X 00 = 52~582.28 X 045 = .00 X 12 = .00 X 15 = NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 135~880.07 83.297 79 52~582.28 .00 52~582.28 (19)= .00 2~366.20 .00 .00 2~366.20 r",nr::n. K~I,;~.I.t"1 (+J AHOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 11-21-2001 CDOO0554 110.53 2~100.00 06-01-2002 CDOO1240 .00 155.67 TOTAL TAX CREDIT 2~366.20 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . If PAID AFTER DATE INDICATED~ SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "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 SCOTT M DINNER ESQUIRE 3117 CHESTNUT STREET CAMP HILL, PA 17011 -------- fold EST ATE INFORMATION: SSN: 192-30-4487 FILE NUMBER: 21-2001- 0857 DECEDENT NAME: SHULDA ROSE MARIE G DATE OF PAYMENT: 11/26/2001 POSTMARK DATE: 11/21/2001 COUNTY: CUMBERLAND DATE OF DEATH: 09/02/2001 NO. CD 000554 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $2,100.00 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: SCOTT M DINNER ESQUIRE CHECK# 226 SEAL INITIALS: CW RECEIVED BY: $2,100.00 MARY C. LEWIS REGISTER OF WILLS 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 NICHOLL DEBORAH ANN 19 CITADEL DR. CAMP HILL, PA 17011 -------- fold ESTATE INFORMATION: SSN: 192-30-4487 FILE NUMBER: 2101-0857 DECEDENT NAME: SHULDA ROSE MARIE G DATE OF PAYMENT: 06/03/2002 POSTMARK DATE: 06/01/2002 COUNTY: CUMBERLAND DATE OF DEATH: 09/02/2001 NO. CD 001240 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $155.67 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: SCOTT M DINNER ESQ CHECK#1449 SEAL INITIALS: AC RECEIVED BY: REGISTER OF WILLS $155.67 MARY C. LEWIS REGISTER OF WILLS PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION B "/ v STATUS REPORT UNDER RULE 6.12 Name of Decedent: Rose Marie G. Shulda Date of Death: September 2, 2001 Estate No.: 21-01-00857 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 xx No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: (date) 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 xx B. The separate Orphans' Court No. (if any) for the personal representative's account is: (Not Applicable in Dauphin County) C. Did the personal representative state an account informally to the parties in interest? Yes xx No D. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date: 8-29 -0 2 Scott M. Dinner, Esq. Name (Please type or print) 3117 Chestnut Street Address Camp Hill, PA 17011 (MAH:nntl AM3) (717) 761-5800 Telephone No. Capacity: Personal Representative R.W. - 58 xx Counsel for Personal Representative REV .1'" EX. (1.001 . . REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT //- ~- ;; COMMO~TH OF PEMlSYLVANA DEPARTMENT OF REVEN.E DEPT. 210601 HARRJSBlJlG. PA 1712~1 - - --~- --.-.-----.-- -"-- --~-- FILE NUMBER 21 01 00857 COUNlY CODE _Y!:,AR_ NUMBER =-1-:0ClAl SECURITY NUMBER 192-30-4487 - '-. .. THIS RETURN MUST BE FILED IN DUPUCATE \MTH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER I i o 3. Remainder Return (date of death prior to 12-13-82) o 5. Federal Estate Tax Return Required t- Z W o w u w o DECEDENrs NAME (LAST, FIRST. AND MIDDLE INITIAL) Shulda, Rose Marie G. 09/02/2001 02/28/1939 (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST. FIRST AND MIDDLE INITIAL) 181 1. Original Return o 181 o 4. Limited Estate DATE OF DEAlli (MM-DD-YEAR) DATE OF BIRlli (MM-DD-YEAR) W t- 1IC:$. u':lIC ~~~ ufm ~ .t- UJz Ww ':0 lSz u2 o 2. Supplemental Return o 4a. Future Interest Compromise (date of death after 12-12-a2) 6. Decedent Died Testate {Attach copy 0 7. Decedent Maintained a Living Trust (Attach of Will) copy of Trust) 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit {date of death between 12-31-91 and 1-1-95 THIS SECTION MUST BE COMPlETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: ME COMPLETE MAILING ADDRESS Scott M. Dinner, Esquire IRM NAME (W applicable) lEPHONE NUMBER 717/761-5800 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) 3117 Chestnut Street Camp Hill, PA 17011 15. Amount cI Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1.2) z 52,582.28 .045 (16) 0 16. Amount cI Line 14 taxable at lineal rate x ~ ~ ~ lL 17. Amount ci Line 14 taxable at sibling rate x .12 (17) ~ u ~ 18. Amount of Line 14 taxable at collateral rate x .15 (18) t- ._---~ 19. Tax Due (19) 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 ~ ~ ~ t- ~ U w II: 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly 0Nned Property (Schedule F) o Separate Billing Requested 7. Inter-VIVOS Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11 , Total Deductions (total Lines 9 & 10) (1) 114,000.00 (2) 8,431. 72 :' (3) None (4) None (5) 13,448.35 (6) None -~-- (7) -0- 1)FHCiAL USE ONLY , I ~ 12. Net Value of Estate (Line 8 minus Line 11) (8) 135,880.07 (9) (10) 8,149.01 75,148.78 (11) 83,297.79 52,582.28 (12) (13) (14) 52,582.28 2,366.20 2,366.20 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAnlENT >> BE SURE TO ANSWER AlL QUESTIONS ON REVERSE SIDE AND RECHECK MATH << Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 6 Westwood Court CITY Enola \ STATE PA I ZIP 17025 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A Spousal POlSty Credit B. Prior Payments C. Discount (1 ) 2,366.20 2,100.00 110.53 Total Credits (A + B + C) (2) 2,210.53 3. InterestlPenalty if applicable D. Interest E. Penalty (3) 0.00 (4) (5) 155.67 (SA) (5B) 155.67 TotallnteresUPenalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3. enter the difference. This is the OVERPAYMENT. CheCk box on Page 1 Une 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. 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 ~ ~: ::~ ~here:i=i~=~:.~.~.~~~.~~.~~.~~~.t.~~~.~.~~..i~~:::::::::::::::::::::::::::::::::::::::::: R ~ d. receive the promise for life ri either payments, benefits or care?................................................................. 0 t81 2. If death occurred after December 12, 1982. did decedent transfer property within one year cl death without receiving adequate consideration?...... .... ..... ....... ...... ..... ..... .......................................... .... ... ...... ..... ....... ......... .... .., 0 ~ 3. Did decedent 0Nn an "in trust far" or payable upon death bank account or security at his or her death?............... 0 ~ 4. Did decedent 0Nn an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designatia1?........................................................................................................................ t81 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury. I declare that I have examined this relum. including accompanying schedules and statements, and to the best of my knowledge and belief. It is true. correct and complete. peclaratiOn of preparer other lhan the pen;on~1 representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS ) 19 Citadel Drive Camp Hill, PA 17011 DATE MAY 3 1 2002 ADDRESS DATE ADDRESS DATE 3117 Chestnut Street CampHill,PA 17011 MAY 3 1 2002 For dates ci 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 cl the surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)l- For dates c:A death on or after January 1, 1995, the tax rate imposed on the nEt value c:A transfers to or for the use c:A the sunliving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)). The statute does neX exemot a transfer to a sunliving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum are still applicable even if the sunliving 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 adopti'lle parent, or a stepparent of the child is 0% [72 P .S. ~9116 (a) (1.2)}. The tax rate imposed on the net value of transfers to or for the use c:A the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116 1.2) [72 P.S. ~116 (a) (1)). The tax rate imposed on the net value cltransfers to or for the use of the decedenfs 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. . SCHEDULE A REAL ESTATE COMMON/\/EAL TH OF PeoNSYL VANA INelITANCE TAX RElUlN RE51DENr OECEOENT I FILE NUMBER I 21-01-00857 ESTATE OF . Shulda, Rose Mane G. All real property owned solelv 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 excflanged 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 jointfy-owned with righf of survivorship must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH personal residence at 6 Westwood Court Enola, Cumberland County, Pennsylvania, per attached settlement 114,000.00 statement --- TOTAL (Also enter on Line 1, Recapitulation) 114,000.00 t\. ~WJ'TLEI\IJ<;NT STATEMENT U,S,IlEI'AI ENT OF 1I0USIN(; ANIlIIJUlAN DEVICLOI'Mf.:N' II U 1)-1 OM 13 No. 2502-0265 II T,'Jle 011.0"" OFIIA 0 !'IlIIIA DCol\v UI1"'S 16, File 1ll1I,,!>e!' nV^ ~C(]I1vlI1S neash 101-125 C NOli.:: rills rU111l is fUlIlish\.:u 10 gIve YOll u stutcrncnt of ilcluill SCl\lClllClll cost. Amounts pOlid to alllJ by lhe settlement agcrll are ShOW11 were: paid outSIUC Ihe closill~1 they arc shown here for infonmHion pU'llOses allllurc 1101 included ill IOlals /) narrower Virginia R. Marquart """,e/address 1190 Kingsley Road Camp Hill, PA 17011- Estate of Rose Marie G. Shulda Deborah Ann Nicholl, Admin. Enola,PA 17025 F Lellder Ilo",e/odr First United Mortgage Services 4931 Carlisle Pike Mechanicsburg, PA 17055 f1, Sellle",cI11 Agel11 Bratic & Portko -rl1ol1e-No 1101 South U.S. Route 15 Dillsburg, PA 17019 J. SUl\lr.11\llY Of. 1I0HHOWEIt'S TIlA;N.SACTlqN. ':.)" ~ 100,G1tllSSAMOIJNTllllEFIlOM'nOIlIWWf.:Il"'\, '" ," 1 0 1 . COlllr'JCI s:\It.:'.i p,it.:e. 114 ~ 00 _0 00 lU~:~~0!}!;:;:~-~:;~~~--~-~~:=~~~ ~~~~ ~;i :i~ ~ ~ ~ : 105, 40'5.------ I'. Sellcl nallle/address 00000000 7 Loafl llUlIlbcI 18 MO!'lgnge Insurnnee ensc No Items I11llrkeu "(po(,;)" G, Properly Loeulioll 6 Wes twood Court, Enol a, PA Zil' Code 17025 I Selllcmclll Dolc 10/19/2001 I'loee ofSelllel11ell1 101 South U. S. Route 15 Dillsburg, PA 17019 K,~U~IMARYOF,sELLI<:R'STHi\N~~CTIO!'l ",'r'~ ,':'.,;.d: 400iCI\OSSI\MOlJNTlllJETOSELLF.I\' "/"",":'", "," .~Q~~COII~" lalc'~~_,______, __~.!14,..QQQ 09.9 !_O 2 . Penou;~~upCrlY.____._________. __ ,.._______.__ Atlius[t11ClllS for items l1aid hy seller in ::l<!V:1l1CC Adiuslmcl\ls for ilcms p:lid by seller in advance ! Q~., crr:.:r~___ _1 OIl2LZOQ~H/3ILZOOL__________.:o.1_..l1 iQ.~:S=C!:2.~_J QL12W1Q~llLllLlI101_ 107.CuUlllyTH _ ,Ta __ _ ~ ___. ___~_ _~_____ _~.2!....:Coull~yTu To lO'~-;;;~'IC-;;j..m.__________.n-r;;----' .--...-- 406.^sscsunent To I09 ~cho~=i~~.l07Ii70i..To ..2.~3ci7~2 -==:::-::-~~18. i1 409, School Tax 10/19/01 To 06/30/02 .!!_<L:.._._____.......____.___.______________ ______.-___ ..!!~___,__ ___u_. .!!.!.:..___..___ __._____..___________ ___ ~.__,,_________ 411. 112, 412. 12 0, (;1l0SS "~IOllNT IHIE FIlOM 1I011l10WEIl 200. Al\lOllNT l'AlllllY Oil IN IIEIIALF OF 1I0lUlOWEH ._ _..!_ 6.1.,11 __ _~l.!~!l.,~:l . - ----- -- "- ---- 118,368.91 420 .GllOSS A~10lJNT DUE TO SELI.Ell 500 .J\lWUCTION IN AMOllNT DUE TO SELLEll 114,889.55 2 _01 . lJq~OUI 01 _C~'IIt'~llllOlIC)' _ _ _ 1.1._ 000 . 00 ~ ~ ii~;~~~~k~~;;::;~- -=~~=~=_ -- ~--~~=-.~QL-~QO~'Q2 ~Q.!:______ ____~______u______ _______ ~22:.....___,._______._____ _____ 206. _ .!Q.~------------------ --------- ~~I!.:----------------------- ____________ 209, AdillSlmcllls rut items unpaid by seller in ~Jv~llce ~!O.mT~_ ____~_____ 211 . CrJIIIlly TlU To ~~^SSCUllW:!~ __.~~__~__~____ ==-=-===~ 213 . -214: 215. _______ u _ .__,,___ _______ ~ ~-------- 217. ---------- ~ !!l.:..._____. _.__._,_________ ______.._ 219. 220, rOTAL l'o\lIl11Y/FUIlIIOIlIlOWEll 100. CASII AT SfTn,E~IENT FllO~lrrO 1I01lllOWEIl 301 . (iross JI1IIlI due (rolll bOlTower fln l20l ] 0 2 . Leu iUlU11 paiJ 1>ylror bonowcr (In 220) 501 . E~ceu l,iI;posit 502. SellltlUCll1 charl.:e:s 10 sellcr (Ill I ~OO) -~03-: [;A.iSlil\,,!oan(s)i~kc~ sub. 10 _ 504 .r.yoffof IJt 1I'V111!:1I~PHF~______ 505 . PiJyoO" ur 2nd IIDr1glgc: loan 506 . Deposil or umc:U /Honey .~07 . SOB. 509- Adiu'lmenl' ror ilem' .."naid by ,eller in ad vallee _510.crrT.. To Sll.CoulU)'Tu To 512 . ^ssessmcnl To 513. 514. 515. 516. 517. 518. 519 . ~~~'74;}lT~T4 _..~._--- ..\.'....11..,_1 '!Q.,7:J, ~.Q.Q.:i! Q 81,000.00 520. TOTAl. 11IWlICTION AMOUNT DIlE S~:I.I.~:1l 600. CASH AT Sr.:rrLEM r.NT TO/FIlOM SELI.Ell 118 3 6 8 . 91 601. Gross ,,,,..I du, 10 "II" fin <20\ B 1 000, 00 602. Less rcll_ ill alllnl due Jeller (Ill 520) 114 889,55 79 422.45 303 . Cash [K] Froll1 Borrower 0 To Borrower 79,422.45 Bcginnil1g Dole: per paymenl 37, 368 . 91 603. Cash [K] To Seller 0 From Sellcr Your cscrow accounl paymcl1t will bc ESCROW ACCOUNT Inili:ll eScrow ::1t:counl st.lIcl1lelllrequircd by Sec:tion IO(c)( I) ur llle I{cal ESl31C Scttkl1lclIl Pi'OccdlllcS ACI (HESI'A) '1l1C tc:rms uf )l1)ur lu.m rc:quire YllU In have ;Hl escrow ;JCCounlIO 3ssme lhal cerl:lin oblig;l!ions 1t:/;.l1illg 10 the lllorlKiJ1;Cll properly, sll(.:il <J'j 1....1.:5. IIlSlllall~,C IHClllllllllS anu otllcl charges are panl. lhe alllOllnl spccilicd below will be collcClcd along wilh your 111000Igage principiJl and inlerest p:Jymcnts, each yeu, while YOllr 3l,;counl is upen 10 pOly these 3111lCip:llciJ expcm,c;.'i III'YCC 35,467.10 PII rposc Antlclpatc'l Due Date EsJimalcd Amollnt A'"l"ol Tolal!'a Illenl SUBSTITUTE FDlll\l 1099 STATEMENT: The inl'"r"'"li"n eonlained in l3Iocks,!!, G 11,1 and on line, 401, 406, 407 is importanl alld i, being r"rnlShed 10 Ihc Inlelllalllevell"e Service Iryou orc reqlllred 10 filc a rcturn, a negligence penollywill be imposed on you iflh;s is req"ired 10 be reported alld Ihe IHS delcrlllllles thaI it has nol becn rcponcd, SELLEllINSTIlIJCTIONS: Iflhis real eslale wos your principal residellce, file Form2119, Sale or E,,"onge or Principal Residence, for allY goin, w:lh your I~comc !:Ix r~lllrn ~ fur olher trtl1l5;lCII0I1S, eomp!clc the llPplicablc parts or Form 471)7, Form 6252 nnd/or Schedule D (form l040) TA XI' A Y Ell III ENTI Fie ATION N UMII Elt CEIlTI FICATI ON: Yo<, arc reqUired 10 provide Ihe ""Iemelll Agenl wilh your COrrCCI laxpayel uJcnllficaliOlll1Ulllbcr If YOll don't provide lllls number, YOll may be subject 10 civil or criminal penalties imposed by law. Under penalties ofpcrjury, J certlry [hat the Illlfllbcr shown un {his slatcl11cnllS my cOrrCClli.lXpayer idenlilicalion number I 'Ill III g.Cl1l..'lalill!\ by dLEGAL'" 1(80U)544..14)7 (Seller's Signa lure) (Seller's Signature) ..:.:fTLl~IVIENT CHARGES (00. TO rAt. SAI.ESlllllOI<En'S COMJ\lISSION U'" _"'price 114,000.00 Division ur CUIUllljS~iull (liue 700) a$ rollows I'AIIJ mOM lIonllOWEn'S FUNDS AT SETTLEMENT I'AIIJ FnOJ\1 SELU:R'S -'.FUNDS~- SI::TIl.EMENT 70 1.__.__. _._________!~_______ 70 2 . To 703. Uepo,i'o( l~Q. 00 Ilcl~by Deborah Ann Nicholl 7'04 ~ Comnyssioll raiJ al seulcmcnt 800. lTr:MS I'A Y AIII.E IN CONNECTION WITH LOAN ~Q._!...:..~~~~~\.~~~~f~__.______._____.______._ 1.50% --.l ~~~Q eo 2. .I.o..n d;S(;Ulllll ____.__.__.__._.__~___.._._____________.___!~~ ~OO . 00 ~80~^l'l'nl"l-r'-e~'-- _~!.t Uni!;~9....ll25 poe 804. C"~;"epao1 1st United $50 poe B 0 5 . ulldcr's inSpcCliou Ice B 0 6 . Mort~3&C ins. I&rpl. rl:C 807 . Assumption Ice 808. Administl1liOIl (ee S09 . DOCWHClll Prcpfcc 810. QvcmiKhl Mail fee _ 811. r-loo~ Cen 'e' _.812. . Bi.:.._. 914 . 900. ITEMS REQUIIlEIJ IIY LENIJEH TO liE rAID IN AllY ANCE 901.lo,cr<$1 (ro"'.lO'121Z0o.1~lLQlL1!lJl.l ~ 13.700000 pcr/~.y -, oi": Mon"ale insu;allce Months 10: 9 0 ] . Ilaun.l lnsurOlllce Mouths 10: 90 4 . MOluhs 10: 9 0 5 . Monlhs to 1000. HESEItVES OI::I'OSITEIl WITH LENIlEII 1001 . Monlllle InSII':IUl:e Months :@ 100 2 . linin.! imi\U"lllcC Mouths :@ 1003 . CilY properly ll11l Monlhs :@ 1004 . Co prope'(1)1liU Monlhs ~ iOO~~;-~;I~--- Months :@ 1006. MOII'h.. :@ !QQZ.c____._ MOlllh.@ 1008. MOllllls :(r9 1009. 1010. ^11I',!.le Escrow ^~'USlllll:O" 1100. TITLE CHAIIGES Northwest Savinas 1st United 1st United 1st United Bank 250.00 175.00 H.OO 24.50 17 J!.".!Q perlMollth per/Mol\lh per/MOIull perIMon1h pe,!Mollth perlMol1th pe,/Month Jler/Month 1101 . Selllel1lC1l1 or dOlillK fee 1102 . Abslnel or tille sc:uch 110 3 . Tille cUlI\in~lion 110 0& . Tille jruurlncc billcJer 1105 . DoCWI'ICnll>CCear:lIioll 110 6 . NUllry rcrt 1107 . AlIomey's reel (ill..:huJes Ib~~! items; 1108 . Tille insllnUlce ~__ (illchKJcs ..!~~.!. itc~H!; 1109 . Lcnc.ler'J COvc:...,c 1110 . Owner'~ co~~~!I!- !111. [!'crow~__ 1112 . Insured Clusillll 111)~--- 1200. GOVF:IlNMENT ItECOlllllNG ANlJ TltANSI'EIlI'f:r:S 1201 . Record;l', !:::,. Deed: 25 . 50 MorllC",e: 1202 . Cily/CO Tllil.!~lan..a: Oeecl 1 , 140 . 0 0 Mon~aae: 120 J . 51'" ru/,""~s; De'~: 1 , 140 . 00 MonK'Ke: 1204 . Rcorder lor ASSignment 14 . 00 1205. 13 00. AOOITlONAL SETn.EJ\1ENT CHARGES 13 0 1. Survey 13 0 2 . rest inspec!ioll 1303 . 4 quo" w.tI,,~ 1) 0.. . Honle iluu(~~.e !.!.Q.~. O...cmi"hl ~~jl 13 0 6 . CluJill1 cnsls 1301 . Inheril;lllce Tu 130 B . Wire trailS fee Ronnetta S. Rider ,----.!!...:.QQ ----~Q..Q Bratic " Portko 1101, 11QL...110I~~5, 60,000.00 114,000.00 NONE NONE Penn Attorney's Title Insurance 45. SO R,le",' East pennsboro Township Farnham Insurance Bratic " portko for mortg!~voff SQlit Buyer/Seller Items 801-1201 but Scott Dinn~uire IOLTA (escrowed) Mellon Bank no t 9 0 1 6 9 . 6:! _-.l.!.:...!~ 244.00,__ 12.00 -1,819.62 ---!LJ!19.6~ /2,000.00 12.00 14 00. TOTAL s~;'n'I.F.MF.NT CIIARGES I have carcfully reviewcd the IIUD-I Selllemcnt Slatcmenl and 10 Ihe best of my knowledge and beli and disbursemcnls made on my acca t or by me inlhis Iransaclion. I further certify Ihall have rec ~ / 3,479.36 4,991.74 (Borrower's Signature) rhe IIUO,.I SClllclllenl Slalemenl which I have prepared is a Irlle und accurale account orlhis Irnnsactian disblHscd In accordancc with Ihis Slalemenl.~. - '.---> "-- l~ ~ n:tc: I 'I -..:J 1 r-fl:: , ~lllemenl Agenl . :onn genera ion )y ~ dLEGAL(i) 'Varnlng: II is a crimc 1.0 knowingly make Calse Slalements 1.0 the United Slates anlhis or any alher sirnilor Corm Penalilies I (800)54444J7 uplln Convlctlan can include a nne or imprisonmenl. ror delails sec' Tille 18 U.S. Code Section 1001 and Seclioll 10 I 0 //) //~Io/ I ' . SCHEDULE B STOCKS & BONDS . COMMONNEAL TH OF PEIHlYLVANlA '~TANCE TAX REflR'j RESlCENT DECEDENT i FILE NUMBER I 21-01-00857 ESTATE OF . Shulda, Rose Mane G. All property jolntly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1 . DESCRIPTION UNIT VALUE 47.32 VALUE AT DATE OF DEATH 7,713.16 163 shares - common stock of Pepsico valued at the average oftbe mean of between the high and low for 8/31/01 and 9/4/01. 2. 12 shares - common stock ofEDS valued at the average of the mean between the high and low for 8/31/01 and 9/4/01. 59.88 718.56 I i I I I I I I i J .~ TOTAL (Also enter on line 2. Recapitulation) 8,431.72 . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMOMNEAL TH OF F'aHlYLVANA Ir.tERITANCE TAX RE1"\RII RESIDENT OECEDENT ESTATE OF . Shulda, Rose Marte G. I I I FILE NUMBER I 21-01-00857 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly~wned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER 1 - DESCRIPTION Waypoint Bank checking account # 1000023613 (see attached stmt.) 2 2001 U.S. Individual Income Tax refund 3 miscellaneous personal property 4 U.S. individual income tax rate reduction rebate 5 EDS compensation related payment TOTAL (Also enter on Line 5, Recapitulation) --'---- VALUE AT DATE OF DEATH 9,776.17 1,293.00 1,750.00 300.00 329.18 13,448.35 Y/Waynoint> I8ANK LOOK FOR US. WE'LL GET YOU THERE. 11/27/2001 SCOTT DINNER 3117 CHESTNUT ST CAMP HILL PA 17011 The information which you requested on the account(s) of ROSE MARIE SHULDA ESTATE (Social Security Number 192-30-4487) is/are as follows: Account Number Class of Account Date Opened Principal Balance Accrued Interest 1000023613 CHECKING 03/09/98 9775.93 .24 . Balance at Date of 9776.17 Death Account Ownership SOLE Name of Joint Owner, if any Date Ownership Was Established Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of Joint Owner, if any Date Ownership Was Established Additional Information Requested PLEASE COMPLETE W-9 terelY,Zkvn, KA~MO~ SENIOR SERVICES REP, Po. Box 1711. HARRISBURG. PENNSYLVANIA 17105-17/1 Toll FrEE 1-866-WAYPOINT (1-866-929-7646) . www.waypointbank.com I Fi-E NUMBER ! 21-01-00857 I This schedule mu~t ~ completed and tiled if the answer to an of uestions 1 throu DESCRIPTION OF PROPERTY DATE OF DEATH % OF Include the neme of the transferee, their relationship to decedent and the date of transfer. VALUE OF ASSET DECO'S Attach a copy of the deed for real estate. INTEREST '* i COMMONWEALTH OF PENNSYLVANIA ..~I INHERITANCE TAX RETURN .RESIDENT DECEDENT ~- ESTATE OF Shulda, Rose Marie G. ITEM NUMBER SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY EDS Retirement Plan - personal pension account payable in equal shares to decedent's four children. 7,978.16 0% I I L_~~ TAXABLE VALUE 0.00 I -~ TOTAL (Also enter on line 7, Recapitulation) . SCHEDULEH FUNERAL EXPENSES & AlJ\INSTRATIVE COSTS COMMO!olNEALTH OF PeNlYLVANlA If\I'ERITANCE TAX RETUlN RESIDENT OECEDENT I FILE NUMBER---- , 21-01-00857 ESTATE OF Shulda, Rose Marie G. Debts of decedent must be reported on Schedule I. ITEM I NUMBER DESCRIPTION A I FUNERAL EXPENSES: . I Musselman Funeral Home, Inc. I 2 I Rolling Green Memorial Gardens I i I I i I AMOUNT 3,306.00 890.11 1. ADMINISTRATIVE COSTS: Personal RepresentatiYe's Commissions B. Social Security Number(s) I EIN Number r:A Personal RepresentatiYe(s): Street Address City State _ Zip Year(s) Commission paid Attomey's Fees Scott M. Dinner, Esquire 2. 1,550.00 3. Family Exemption: (If decedent's address is not the sane as claimant's, attach explanation) Claimant Street Address City S~e Relationship r:A Claimant to Decedent Probate Fees Cumberland County Register of Wills Zip 4. 229.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Other AdrninistratNe Costs settlement charges - 6 Westwood Court (net of$889.55 in adjustments for items paid in advance and $2,000.00 for tax escrow) per HUD-l. 2,102.19 2 3 expense reimbursement to Ronald L. Shulda, Jr. for signage, etc.. for sale of6 Westwood Court REV-1500 filing fees 56.71 15.00 Total of Continuation Schedule(s) TOTAL (Also enter on line 9, Recapitulation) I I - I , 8,149.01 *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMOMNEAL 1M OF PEIHlYLVANA IN-tERlTANCE TAX RElUlN RESIDENT DECEDENT \ FILE NUMBER I 21 - 01 - 00857 ESTATEOF Sh Id R M' G u a. ose ane . Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 first mortgage on 6 Westwood Court - Enola., Pennsylvania held by the P A Housing Finance Agency (see attached HUD-l Settlement Statement line 504). 73,430.71 2 Scott M. Dinner, Esq,. - legal fees (power of attorney) 75.00 3 West Shore EMS - ambulance services 90.75 4 Holy Spirit Hospital 86.88 5 Pinnacle Health Systems 50.00 6 PPL - electric service 34.06 7 Verizon - telephone/long distance service 82.95 8 PHF A - mortgage payments (Sept./Oct. '0 l) 1,258.00 9 Pennsylvania American Water - water service 40.43 TOTAL (Also enteron Une 10, Recapitulation) 75,148.78 *' SCHEDULE J BENEFICIARIES I I I L. I FILE NUMBER I 21-01-00857 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Shulda. Rose Marie G. NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERlY I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) Deborah Ann Nicholl nee Shulda 19 Citadel Drive Camp Hill, Pennsylvania 17011 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE OF ESTATE Daughter one-fourth (1/4) of residuary estate 2 Ronald L. Shulda. Jr. 614 N. Front Street Wormleysburg, Pennsylvania 17043 Son one-fourth (1/4) of residuary estate 3 Beverly Ann Lafever nee Shulda 1925 Chatham Drive Camp Hill, Pennsylvania 17011 I Daughter one-fourth (1/4) of residuary estate 4 Tammy Ann Danner nee Shulda 671 Wyndamere Road Lewisberry, Pennsylvania 17339 Daughter one-fourth (1/4) of residuary estate i Enter dollar amounts for distributions shown above on lines 15 through 17, as appropriate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE I I 10_ CHARITABlE AND GOVERNPoENTAl DISlRIBUTIONS I I I I TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETi -.--~ ._-~--_. _._~_._- ._~---_....~~~._~L~. ~--- Register of Wills of CUMBERLAND County, Pennsylvania Certificate of Grant of Letters No. 2001-00857 PA No. 21-01-0857 ESTATE OF SHULDA ROSE MARIE G (LA~l, rlK~l, M1UULc) Late of EAST PENNSBORO TOWNSHIP CUMHcKL~U CUUN1Y, Deceased Social Security No. 192-30-4487 day of September 2001 an instrument WHEREAS, on the 18th dated July 19th 2001 was admitted to probate as the last will of SHULDA ROSE MARIE G (LA~l', t'lK::il, iVllLJULc) late of EAST PENNSBORO TOWNSHIP CUMBERLAND County, who died on the 2nd day of September 2001 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, MARY C. LEWIS , Register of Wills in and for the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to NICHOLL DEBORAH ANN who has duly qualified as Executor (rix) and has agreed to administer the estate according to law, all of which fully appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my Office the 18th day of September 2001. lr;Oi C ifu~ f);J)~ ~Yi';l egls,:e 0 1 S **NOTE** ALL NAMES ABOVE APPEAR (LAST, FIRST, MIDDLE) Scott M. Dinner Atto.....y .t L.~. 3117 Cbeltnut Street C.mp H;U. PA 17011 1<01, (717) 761-5800 r....., 17\ 7) 761-5008 ',.-'.;;J'..;,<'.<:' ,: >",.' '. "*.'~ ;~";!!!1:--','.. . '...., LAST WILL OF ROSE MARIE G. SHULDA I, ROSE MARIE G. SHULDA, presently of 6 Westwood Court, Enola, Cumberland County, Pennsylvania, declare this to be my Last Will hereby revoking all Wills and Codicils previously made by me. I declare I have four children born to me and now living: Deborah Ann Nicholl nee Shulda, born May 30, 1960, Ronald L. Shulda, Jr., born July 17, 1962, Beverly Ann Lafever nee Shulda, bOrn March 23, 1964, and Tammy Ann Danner nee Shulda, born May 9, 1965. All references in this Will to 'my children' include only those four individuals named above. ARTICLE I Payment of DebtslExDenses: I direct the payment of my debts, including the expenses of my last illness and funeral, from my estate as soon after my death as conveniently may be done. I ARTICLE II Personal Property and Household Effects: I give certain items of my household furnishings and tangible personal property to my friends and family in accordance with the terms of Scott M. Dinner Attorney .t L.". 311 7 Cbe.tnut SI,,",' Cmp H;If. PA 17011 ...,1, 17171 7bl.5800 f..., 17171 7bl.5008 -2- a written memorandum which I have prepared. I bequeath any such property not disposed of by such memorandum, or all of such property if the memorandum is not located or received by my Personal Representative, to my children who survive me to be divided among them by my Personal Representative (with due regard for their personal preferences) in as nearly equal shares as practical. Ifthe written memorandum referred to in this ARTICLE II is not located or received by my Personal Representative within sixty (60) days after taking office as such, after and upon the conducting of a reasonable search for such memorandum, the Personal Representative shall be held harmless for distributing such property as hereinbefore provided. ARTICLE III Residuary Estate: I do give and bequeath the rest, residue and remainder of my estate, both real, personal and mixed, of whatsoever kind and wheresoever situate equally to my children who survivie me, per capita. ARTICLE IV Personal Representative: I nominate and appoint my daughter, Deborah Ann Nicholl, to serve as Personal Representative of this Will. In the event of the death, resignation, renunciation or inability to act of my daughter, Deborah Ann Nicholl, then I appoint my son, Ronald L. Shulda, Jr., as my successor Personal Representative of this Will in her place and stead. Scott M. Dinner l\ttorney .t L.w :',117 Che.tnul Stn.et C.~p Hill. PA 17011 tel. (717) 761-5800 (0.%' (717) 761-5008 .J ARTICLE V Fiduciary's Performance and Powers: No fiduciary under this will shall be required to give bond or other security for the faithful performance of the fiduciary's duties. Any such fiduciary shall have the following powers, in addition to those given by law: 1. To retain any property, pending distribution hereunder, to invest in or purchase any property without restriction to legal investments for fiduciaries (except for those fiduciaries subject to the Pennsylvania Prudent Investor Act), to distribute property in kind, to disclaim any interest in property, and to sell any property at public or private sale; 2. To hold shares of stock or other securities in nominee registration form., including that ofa clearing corporation or depository, orin book entry fonn or unregistered or in such other form as will pass by delivery~ 3. To engage in litigation and compromise, arbitrate or abandon claims; 4. To make distributions in cash, or in kind at current values, or partly in each, allocating specific assets to particular distributee on a non-prorata basis, and for such purposes to make reasonable determinations of current values; 5. To make elections, decisions, concessions and settlements in connection with all income, estate, inheritance, gift or other tax returns and the payment of such taxes, without obligation to adjust the distributive share of income or principal of a any person affected thereby; 6. To borrow money from any person including any fiduciary acting hereunder, and to mortgage or pledge any real or personal property; 7. T3 manage, control, repair and improve all estate property~ 8. To procure and carry at the expense of the Estate, insurarIce of the kinds, forms and amounts deemed advisable by my Personal representative to protect the Estate against arIY hazard; 9. To employ any attorney, investment adviser, accountant, broker, tax specialist or any other agent deemed necessary in the discretion of my Personal Representative and/or my Trustee~ and to pay from my estate arid/or the Trust estate reasonable compensation for all services performed by any of them. ,. -4- ARTICLE VI Death Taxes: I direct that all inheritance, estate, transfer, succession and death taxes, of any kind whatsoever, other than any generation skipping taxes, (including any interest and penalties thereon), which may be payable by reason of my death with respect to: (i) property passing under this Will or (ii) any of my nonprobate property, shall be paid out of the property giving rise to such taxes on an incremental tax basis. ARTICLE VII Protection from Improvidence: No interest of any beneficiary under this Will or any codicil hereto shall be subject to anticipation or voluntary or involuntary alienation. ARTICLE VIII Invaliditv: If any provision of this Will or of any codicil hereto is held to be inoperative, invalid or illegal, it is my intention that all of the remaining hereof shall continue to be fully operative and effective so far as it is possible and reasonable. Scott M. Dinner Atto....ey At LAW 3117 Cheatnut S_ C.mp Hill. PA 17011 tel. (717) 761-5800 f..." (717) 761.5008 IN WITNESS WHEREOF, I have subscribed hereunto and caused this my Last Will, consisting of six (6) typewritten pages, including this attestation clause, to be executed, declared and published this 19th day of July, 2001, at Errola, Pennsylvania. ~~t/l#Av ROSE MARIE G.' HULDA Witnesses: 7#~d404~(! / Residing at 771 C:~rrirlqe Lane Mechanicsburg, PA 17050 ~'&J . 'l{ ," .' ~X-V'-rA/' Residing at 111 Sholly Dr i ve Mechanicsburg, PA 17055 I ..~_ k(f)J!J;j,41r~'VJ ~/ ' 111 Sholly Drive Residing at Mechanicsburg, PA 17055 Scott M. Dinner Att<>rn.y .t L.w 311 7 a...mut Street Camp H;lI. PA 17011 k\, (717) 761-&800 f..., (717) 761-5008 ...- -_._~ . ACKNOWLEDGMEN'J' AND AFFIDAVIT COMMONWEAL TH OF PENNSYL VANIA) COUNTY OF CUMBERLAND ) We, Rose Marie G. Shulda, H. Robert Be1che, Pamela J. Dinner, and Scott M. Dinner, the Testatrix and the witnesses, respectively, whose names are signed to the foregoing instrument, being duly qualified according to law, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will, that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, that each of the witnesses, in the presence and hearing of the Testatrix signed the Will as witnesses and that to the best of the witnesses' knowledge, the Testatrix was at the time eighteen or more years of age, of sound mind and under no constraint or undue influence. Rose Marie G. Shulda, Testatrix Witnesses: ~~~~ y;~ 9, ~ ~~ .. . o{. vtlL~ f./ Scott M. Dinner On this, the ;}4~ay of July, 2001, before me, Dawn M. Boyer, the undersigned officer, personally appeared Scott M. Dinner, Esquire, known to me to be a member of the Bar of the Supreme Court of Pennsylvania, and certified that he was personally present when the foregoing Acknowledgment and Affidavit was signed by the Testatrix and witnesses. Attorney .t L..... 311 7 Cbc.tnut s~ CAmp Hill. PA 17011 u.L 17171 761-5800 fA%' (7171 761.5008 ~~~~ Notary Public \ "'. ~. -- ..--...-- No:arial Seal Dawn M. Boyer, Notary Public Lower Allen Twp., Cumberland County My Commission Expires Dec. 15,2001 Member, Pennsylvania ASSOCiation ot Nolane,