HomeMy WebLinkAbout01-1013
1/-/9- /
~. BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG1 PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT3 ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
KEITH 0 BRENNEMAN ESQ
SNELBAKER ETAL
44 W MAIN ST
MECHANICSBURG
'01
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
f) ".:1 -nt::,COUNTY
I ,.. 'J-'ACN
06-17-2002
SHIELDS
10-10-2001
21 01-1013
CUMBERLAND
101
JUfi,J 21
'*
REY-1547 EX AFP (01-02)
PAUL
J
Allount Rellitted
L..
PA 17oS5HL
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE3 PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iE-v :i54-j-Ex--iFP-fol-:021--NiiTicE--oF-'rNHEifi;:Ai'-cE-~''-Ai-APPRjrisEiiENT~--i[l-owAi'-cE-iri-------------- ---
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SHIELDS PAUL J FILE NO. 21 01-1013 ACN 101 DATE 06-17-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. Hortgages/Notes Receivable (Schedule D) (4)
5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
NO. 01
.00
.00
.00
.00
347.88
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Hisc. Expenses (Schedule H) (9)
10. Debts/Hortgage Liabilities/Liens (Schedule I) (10)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
.00
.00
lll)
ll2)
ll3)
ll4)
NOTE: I~ an assessment was issued previously, lines
re~lect ~igures that include the total o~ ALL
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 CREDITC:;
NOTE: To insure proper
credit to your account3
subllit the upper portion
of this forll with your
tax paYllent.
347.88
00
347.88
.00
2773339.61
14, lS and/or 16, 17, 18 and 19 will
returns assessed to date.
713759.53 X 00 =
2053580.09 X 045 =
.00 x 12 =
.00 X 15 =
ll9)=
.00
93251.11
.00
.00
93251.11
-
-ft. n~1'I1 KI:l;I:J.t'I n I+J
DATE NUHBER INTEREST/PEN PAID (-) AHOUNT PAID
01-07-2002 CDOO0723 462.56 83850.00
03-18-2002 REFUND .00 71.36-
PAYMENT MUST BE MADE BY 07-10-2002~. TOTAL TAX CREDIT 93241.20
BALANCE OF TAX DUE 9.91
INTEREST AND PEN. .00
TOTAL DUE 9.91
. IF PAID AFTER DATE INDICATED3 SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $13 NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)3 YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
No 21 - 01 - 1013
.
Estate of
Paul J. Shields
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW NOVEMBER 5 t 1'$ 200,}.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 September 18, 1997
described therein be admitted to probate and filed of record as the last will of
Paul .T_ Shi~lds
and Letters rpp~t-ampnt-ary
are hereby granted to Randall A. Shields
Register of ills
MARY CLEWIS
/~~
~.
\j
FEES
$ 18 . 00
$ q 00
$
$ 6.00
5.00
TOTAL - $ 38.00
Filed ... N.Q~~~.B.~R. 5.,. .~OO.1....... ......
Probate, Letters, Etc. .........
Short Certificates( 3) . . . . . . . . . .
Renunciation ................
X-PAGES
JCP
A TIORNEY (Sup. Ct. I.D. No.)
Keith O. Brenneman 147077
44 W. Main Street
ADDRESS
Mechanicsburg, PA 17055
(717) 697-8528
PHONE
Called attorney on 11-5-01.
/
/'
H105.112 REV 8/88
(FEE FOR THIS
CERTIFICATE 52.001
WARNING: IT IS IllEGAL TO ALTER THIS COpy OR
TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF HEALTH VITAL RECORDS
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
CERT. NO. T 4 9 9 4 5 6 9
10-15-2001
Date of Issue of This Certification
Name of Decedent
Paul
J .
Shields
First
Middlo
Last
Sex
Male
Social Security No.
188-12-3440
Date of Death
10...10-2001
Date of Birth May 18, 1922
Birthplace
Grundy Center, Iowa
Place of Death
Harrisburg Hospital
Dauphin
Harrisburg
Pennsj.o'lvania
Facility Name
County
City, Borough or Township
Race
White
Marital Status
Married
Occupation
Decedent's
Mailing Address 552 Brighton Place
Number Street
Chief Deliveryman
Armed Forces? (Yes or No)
Yes
Mechanicsburg
PA 1705
City or Town
State
Informant Randall A. Shields
Name and Address of
Funeral Establishment
Funeral Director
James F. Nickel
Nickel Funeral Home, Loysville, PA 17047
Part I:
Immediate Cause
Interval Between
Onset and Death
(a)
Respiratory failure
(b)
Myocardial infarction
(c)
Part II:
(d)
Other Significant Conditions
Manner of Death
Natural ~
Accident 0
Suicide 0
Describe how injury occurred:
Homicide
Pending Investigation
Could not be Determined
o
o
o
Name and Title of Certfier
Ronald Williams
M.D.
(M.D., D.O., Coroner, M.E.)
Address
2601 N. 3rd St., Harrisburg, PA 17110
This is to certify that the information here given is correctly copied from an original certificate
of death duly filed with me as Local Registrar. The original certificate will be forwarded to the
State Vital Records Office for permanent filing.
5
10-12-2001
Date RACei\'ed b~! Local Registrar
101 Barnett St.. New Bloomfield. PA 17068
Street Address City. Borough, Township
LAW OFFICES
SNELBAKER.
BRENNEMAN
& SPARE
LAST WILL AND TESTAMENT
OF
PAUL J. SHIELDS
I, PAUL J. SHIELDS, of Upper Allen Township, Cumberland
County, Pennsylvania, being of sound and disposing mind, memory
and understanding, do hereby make, publish and declare 'this as
and for my Last will and Testament, hereby revoking and making
void any and all wills by me at any time heretofore made.
1. I direct that all my debts and funeral expenses be paid
as soon as practical after my death by my Executor hereinafter
named.
2. All the rest, residue and remainder of my estate, real,
personal and mixed, and t'\Theresoever the same may be situate,
I give, devise and bequeath to my son, RANDALL A. SHIELDS.
Should my son, RANDALL A. SHIELDS, predecease me, I
give, devise and bequeath all the rest, residue and remainder of
my estate, real, personal and mixed, and wheresoever the same may
be situate, in equal shares to my grandson, WILLIAM R. SHIELDS,
and my granddaughter, JACLYN L. SHIELDS.
4. I hereby nominate, constitute and appoint my said son,
RANDALL A. SHIELDS, as Executor of this my Last will and
Testament. I further direct that no person serving as Executor
hereunder shall be required to post any bond to secure the
faithful performance of his duties in the Commonwealth of
Pennsylvania or in any other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to
LAW OFFICES
SNELBAKER.
BRENNEMAN
Be SPARE
4
this my Last will and Testament written on Two (2) pages this
18th day of September, 1997.
-Pevuk r} cfrtU~(SEALl
Paul J. Shields
signed, sealed, published and declared by PAUL J. SHIELDS,
the Testator above named, as and for his Last will and Testament,
in our presence, who, in his presence, at his request, and in the
presence of each other, have hereunto subscribed our names as
attesting witnesses.
K~~4~
( SEAL)
~ C~ i: pASEALl
-2-
COMMONWEALTH OF PENNSYLVANIA)
SSe
COUNTY
OF
CUMBERLAND)
We, PAUL J. SHIELDS, KEITH O. BRENNEMAN, ESQUIRE and SUSAN
L. ZYCH, the Testator and the witnesses, respectively, whose
names are signed to the attached or foregoing instrument, being
first duly sworn, do hereby declare to the undersigned authority
that the Testator signed and executed the instrument as his Last
will and Testament and that he had signed willingly, and that he
executed it as his free and voluntary act for the purposes
therein expressed, and that each of the witnesses, in the
presence and hearing of the Testator, signed the will as witness
and that to the best of his or her knowledge the Testator was at
that time eighteen years of age or older, of sound mind and under
no constraint or undue influence.
~c/6~
-d~
Witness
-4~~;( ~~
WJ.tne
Subscribed, sworn to and acknowledged before me by PAUL J.
SHIELDS, Testator, and subscribed and sworn to before me by
KEITH o. BRENNEMAN, ESQUIRE and SUSAN L. ZYCH, witnesses, this
18th day of September, 1997.
q~Q~
Notary Public
LAW OFFICES
SNELBAKER.
BRENNEMAN
Be SPARE
-..:,.......
LA W OFFICES r.)
SNELBAKER.
BRENNEMAN ' ~
Be SPARE
CERTIFICATION OF NOTICE UNDER RULE 5.6(A)
Name of Decedent: Paul J. Shields
Date of death: October 10, 2001
0\
Administration No.: 21~1013
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 beneficiary of the above-captioned Estate on
November 14,2001.
Name
Marietta Shields
Randall A. Shields
Address
Room 107
Seidle Hospital
120 S. Filbert Street
Mechanicsburg, P A 17055
and
552 Brighton Place
Mechanicsburg, P A 17055
2 Skywood Court
Baltimore, MD 21234-1421
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None.
Dated: November 14,2001
M
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Keith O. Brenneman, Esquire
Snelbaker, Brenneman & Spare, P. c.
44 West Main Street
Mechanicsburg PA 17055-0318
Capacity: _ Personal Representative
-.X. Counsel for personal representative
LA W OFFICES
SNELBAKER.
BRENNEMAN
& SPARE
IN RE: ESTATE OF PAUL J. SHIELDS, : IN THE COURT OF COMMON PLEAS OF
Deceased : CUMBERLAND COUNTY, PENNSYLVANIA
: NO. 21-01-1013
: ORPHANS' COURT DIVISION
NOTICE OF SURVIVING SPOUSE'S ELECTION TO
TAKE ELECTIVE SHARE PURSUANT TO 20 Pa.C.S.A. 2210(a)
I, Marietta Shields, surviving spouse of Paul J. Shields, hereby elect to take my elective
share against the Will and/or Estate of Paul 1. Shields.
Date: 1-'1 "'"-0" C J
N'\,,-~.....~ ~e \~.
Marietta Shields
By: R~~~ L ~() ~" ~..'...ft\). "
Randall A. Shields, attorney-in-fact
po
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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
BRENNEMAN KEITH 0
44 W MAIN STREET
MECHANICSBURG, PA 17055
-------- fold
ESTATE INFORMATION: SSN: 188-12-3440
FILE NUMBER: 21 - 2001 - 1 01 3
DECEDENT NAME: SHIELDS PAUL J
DA TE OF PAYMENT: 01/07/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 1 0/ 1 0/2001
NO. CD 000723
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $8,850.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$8,850.00
REMARKS: KEITH 0 BRENNEMAN ESQ.
CHECK#1015
SEAL
INITIALS: AC
RECEIVED BY:
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
SNELBAKER, BRENNEMAN 8 SPARE
^ PROFESSIONAL CORPORATION
AITORNEYS AT LAW
MECHANICSBURG, PENNSYLVANIA 17055
44 WEST MAIN STREET
RICHARD C. SNELBAKER
KEITH O. BRENNEMAN
PHILIP H. SPARE
Mary Lewis, Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, P A 17013
Re: Estate of Paul 1. Shields
Estate No. 2001-01013
PA No. 21-01-1013
Dear Ms. Lewis:
717-697-8528
January 7, 2002
BY HAND DELIVERY
~/
P o. BOX 318
FACSIMILE (717) 697-7681
Enclosed please find a check payable to Register of Wills, Agent in the amount of
$8,850.00 representing pre-payment of the inheritance tax with respect to the above Estate.
KOB/sz
Enclosure
CC: Randall A. Shields, Executor
Yours truly,
IJf~~
Keith O. Brenneman
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STATE OF MARYLAND
COUNTY OF ~
~ LV Prf..,O .
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55:
Randall A ~hiplrl~
.being duly sworn according to law, deposes and says that he is the
Executor of the Estate of Paul J. Shields
late of -1].pper AIJ..Jiill.._~Qwnship , Cumberland County. Pa.. deceased and that the
within is an inventory made by Randall A. Shields_ , the said Executor
of the entire estate of said decedent, consisting of all the personal prop~rty and real estate. except real estate outside
the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value
as of the date of decedent's death.
and subscribed before me,
l~x 2002
Ro.... ~- ~ ~ ~a~\.~
Executor. Administrator
2 Skywood Court
My CooInIssIon ExpIres
lay 1 t 2005
Baltimore, MD 21234
Addr.ss
Date of Death
10
Day
October
Month
2001
Y.ar
INSTRUCTIONS
I. An inventory must be filed within three months after appointment of personal representative.
2. A supplement inventory must be filed within thirty days of discovery of additional assets.
3. Additional sheets may be attached as to personalty or realty
4. See Article IV, Fiduciaries Act of 1949.
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lnventory of the real and personal estate of
Paul J. Shields,
deceased
-I . REAL ESTATE
A. 552 Brighton Place, Upper Allen Township, Cumberland
County, Pennsylvania (condominium unit).
Appraised Value:
TOTAL VALUE, PERSONALTY:
11,500 00
TOTAL VALUE, REAL ESTATE:
II. PERSONALTY
A. First Union Securities, Account No.
7963-7005:
B. PNC Bank, N.A., Checking Account No.
50000998192:
12,244.
C. Miscellaneous furniture, furnishings a'nd
property:
83
TOTAL VALUE, REAL ESTATE AND PERSONALTY:
83
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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
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
03-25-2002
SHIELDS
10-10-2001
21 01-1013
CUMBERLAND
101
RtK'
KEITH 0 BRENNEMA~ES~R -1
SNELBAKER ETAL
44 W MAIN ST Cis:
MECHANICSBURG Cl;lf~;}7055
P12 :48
*'
REY-1547 EX iFP (01-02'
PAUL
J
Allount Rellitted
Cl)
(2)
(3)
(4)
(5)
(6)
(7)
111,500.00
.00
.00
.00
18,544.83
.00
163,704.60
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 ~
REY=is4j-Ex-iFP-fol-':ozl--NcfficE--oF-'rtiHEifiTANci-YAX-APPRAisEMENY-,--iii-oWANCi-oi-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SHIELDS PAUL J FILE NO. 21 01-1013 ACN 101 DATE 03-25-2002
TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE
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
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tex
(9)
ClO)
16,292.41
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
(8)
293,749.43
465.29
Cl1)
Cl2)
Cl3)
Cl4)
1".757 70
276,991.73
.00
276,991.73
NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ abb 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:
71,643.57 X 00 = .00
205,348.17 X 045 = 9,240.67
.00 X 12 = .00
.00 X 15 = .00
Cl9)= 9,240.67
, ..., n..'..' 'u.ow...... , II l + J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
01-07-2002 CDOO0723 462.03 8,850.00
03-18-2002 REFUND .00 71.36-
TOTAL TAX CREDIT 9,240.67
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 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 TION
OF CHANGES
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENTS NAME
Paul J. Shields
FilE NUMBER
REVIEWED BY
Sheila Megonnell
ACN
2101-1013
101
ITEM
SCHEDULE NO.
G 1
EXPLANATION OF CHANGES
The IRA is fully taxable as the decedent is the primary owner and the transferee is a
beneficiary not a joint owner.
H
Repairs cannot be used as deductions against the decedent's estate unless the real
estate has been sold.
ROW
Page 1
~
1~-/9- I
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*'
REY-1U7 EX AFP U1-02)
KEITH 0 BRENNEMAN ESQ"02
SNELBAKER ETAL
44 W MAIN ST
MECHANICSBURG
I~oc 20 D '";I .~.) 1
If 1\ ../ I.J-1-
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
04-01-2002
SHIELDS
10-10-2001
21 01-1013
CUMBERLAND
101
PAUL
J
Allount Rellitted
t~.,.
PA ,'X~~~"
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, subllit the upper portion of this for.. with your tax paYIIBnt.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV=i6'ifj-ix--AFP--foi-:02-f------...-iNHERiTANC'E-yiX--STAfEME-tiy-cfF'-ic-couiif--.-..---------------- -----
ESTATE OF SHIELDS PAUL J FILE NO. 21 01-1013 ACN 101 DATE 04-01-2002
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 03-25-2002
PR I NCI PAL TAX DU E : ..._...._................................................_..............................................................................................................................................................
9,240.67
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
01-07-2002 CDOO0723 462.03 8,850.00
03-18-2002 REFUND .00 71.36-
TOTAL TAX CREDIT 9,240.67 I
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 PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ,
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J
~
REV-l500 EX (6.QO)
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'* COMMONWEAITHOF
PENNSYLVANIA
. DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Shields, Paul J.
DATE OF DEATH (MM-DD-YEAR)
10 10 2001 5 18 1922
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Shields, Marietta
D 1. Original Return
D 4. Limited Estate
D 6. Decedent Died Testate (AI1ach copy of WiU)
D 9. Litigation Proceeds Received
[3 2. Supplemental Return
D 4a. Future Interest Compromise (date of death after 12-12-82)
D 7. Decedent Maintained a Living Trust (Allach copy of Trust)
D 10. Spousal Poverty Credit (date of death belween 12-31-91 and 1-1-95)
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FILE NUMBER
2 1- 0 1
COUNTY CODE YEAR
o 101 3
-----
NUMBER
SOCIAL SECURITY NUMBER
188
12
3440
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
172
24 -
9184
D 3. Remainder Return (date of death prior to 12-13-82)
D 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
D 11. EJection to tax under Sec. 9113(A) (Allach Sch 0)
NAME COMPLETE MAILING ADDRESS
Keith O. Brenneman, Es uire
FIRM NAME (If Appicable)
Snelbaker, Brenneman & S are, P.
TELEPHONE NUMBER
(717) 697-8528
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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 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)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent. Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
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)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(9)
(10)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
115.96
231.92
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
44 W. Main Street
Mechanicsburg, PA
347.88
x .0 JL (15)
x .0 ~ (16)
x .12 (17)
x .15 (18)
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
17055
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(8)
347.88
(11 )
(12)
(13)
347.88
(14)
347.88
10.44
(19)
10.44
.
,
Decedent's Complete Address:
STREET ADDRESS
552 Bri hton Place
CITY
Mechanicsbur
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
10.44
Total Credits (A + B + C ) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
TotallnterestlPenalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If line 1 + line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
10.44
(5)
(SA)
(5B)
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
10.44
Make Check Payable to: REGISTER OF WILLS, A GENT
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred;.......................................................................................... 0
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0
c. retain a reversionary interest; or.......................................................................................................................... 0
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0
2. If death occurred after December 12, 1982, did decedent transfer property within one 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
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ !J
No
;
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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~ury, I declare that I have examined this retum, Induding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete.
Dedaration of preparer other than the personal representative is based on an information of which preparer has any knowledge.
SIGNAT PERSON RESPONSIBLE FOR FILING RETURN
~ ..
, Executor
ADDRESS
ADDRESS
SIGNATURE
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DATE
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DA E
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. 99116 (a) (1.1) (i)1.
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 surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)J.
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)J.
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(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.
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COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Paul J. Shields
FILE NUMBER
21-01-1013
Include the proceeds of litigation and the date the proceedS were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Refund, Medicare Supplemental Health Insurance 249.82
2. Refund, prescription drug plan 18.17
3. Refund, automobile insurance 75.55
4. Refund, MetLife Group Life Insurance 4.34
TOTAL (Also enter on line 5, Recapitulation) $ 347 . 88
(If more space is needed, insert additional sheets of the same size)
.-.- ,
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REV-1S13 EX+ (2-''''
'*
COMMONWEALTH Of P~NNSYLVANIA
INHE.nANeE TAX lnulN
IESlDENT DECEDENT
SCHED'ULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
Paul J. Shields
21-01-1013
ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR
NUMBER SHARE OF EST A TE
A. Taxable Be.quests:
1. Randall A. Shields Son Residue of Es
2 Skywood Court
Baltimore, MD 21234
Marietta Shields Surviving Spousal Elect
Room 107, Seidle Hospital Spouse 1/3 of net pr
120 S. Filbert Street Estate
Mechanicsburg, PA 17055
tate
ion:
abate
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
AMOUNT OR
SHARE OF ESTATE
B. Charitable and Governmental Bequests:
1.
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) S
(If more space is needed, insert additional sheets of same size)
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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
BRENNEMAN KEITH 0
44 W MAIN STREET
MECHANICSBURG, PA 17055
-------- fold
ESTATE INFORMATION: SSN: 188-12-3440
FILE NUMBER: 2101-1013
DECEDENT NAME: SHIELDS PAUL J
DATE OF PAYMENT: OS/24/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 10/10/2001
NO. CD 001211
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $10.44
I
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TOTAL AMOUNT PAID:
$1 0.44
REMARKS: KEITH 0 BRENNEMAN ESQUIRE
CHECK#1043
SEAL
INITIALS: VZ
RECEIVED BY:
REGISTER OF WILLS
MARY C. LEWIS
REGISTER OF WILLS
LAW OFFICES
SNELBAKER.
BRENNEMAN
Be SPARE
ESTATE OF PAUL J. SHIELDS, DECEASED
NO. 21-01-1013
FIRST AND FINAL ACCOUNT OF RANDALL A. SHIELDS,
EXECUTOR UNDER THE LAST WILL AND TESTAMENT
OF PAUL J. SHIELDS, DECEASED, LATE OF UPPER ALLEN,
TOWNSHIP, CUMBERLAND COUNTY, PENNSYLVANIA
RANDALL A. SHIELDS, EXECUTOR and Accountant herein
avers as follows:
DATE OF DECEDENT'S DEATH:
October 10,2001
DATE LETTERS TESTAMENTARY ISSUED:
November 5, 2001
LETTERS TESTAMENTARY WERE ADVERTISED AS FOLLOWS:
The Patriot-News Co.:
November 27, December 4, 11,2001
Cumberland Law Journal:
November 23,30, December 7,2001
DATE OF RULE 5.6(A) CERTIFICATION:
November 14, 2001
PERSONALTY - PRINCIPAL ACCOUNT
DEBITS
The Accountant charges himself with receipt of the Decedent's personal
property as more fully set forth in the Inventory and Appraisement
filed in the Office of the Register of Wills for Cumberland County,
Pennsylvania on January 22,2002 ($18,544.83) together with the
following additional sums:
Refund, Medicare Supplemental Health Insurance:
Refund, prescription drug plan:
$249.82
18.17
LAW OFFICES
SNELBAKER.
BRENNEMAN
& SPARE
Refund, automobile insurance:
Refund, MetLife group life insurance:
75.55
4.34
Total:
TOTAL, PERSONALTY, PRINCIPAL ACCOUNT, DEBITS:
PRINCIPAL CONVERSIONS INTO CASH
The Accountant claims the following gains/losses associated with principal
conversions into cash:
First Union Securities, Account No. 7963-7005
Date of Death Value:
Sums withdrawn to close of account:
$5,790.11
6.365.80
Net Gain/Loss:
TOTAL, PERSONALTY, PRINCIPAL CONVERSIONS:
PERSONALTY - PRINCIPAL ACCOUNT
CREDITS
The Accountant claims credit for payment of the following items from
personalty principal:
Checks posted to Decedent's checking account after date of death:
United Water Pennsylvania:
William Shields:
Upper Allen Township:
$ 14.94
101.75
100.00
Total:
Nickel Funeral Home - funeral expense
Rev. Julie Hart - honorarium for services
St. Paul's Church and Social Committee - services and luncheon
-2-
$18.892.71
$18.892.71
$575.69
$575.69
$ 216.69
6,552.60
200.00
1,000.00
Snelbaker, Brenneman & Spare, P. C. - reimbursement of costs advanced:
Initial probate fee:
Cumberland Law Journal:
Patriot News:
Register of Wills - Spousal Election:
$38.00
75.00
96.81
15.00
Total:
Snelbaker, Brenneman & Spare, P. C. -legal fees to 1/31/02
Chuck Bricker, Auctioneer - appraisal of personalty
Pinnacle Health Hospital - payment on account
Register of Wills, Agent - inheritance tax on probate assets
Register of Wills - additional probate fee
U. S. Postal Service - postage
The Patriot News - payment on account
Bank of America - check printing fee
Pinnacle Health Hospital - payment on account
Pinnacle Health Hospital - payment on account
The Accountant reserves the following sums to be paid subsequent to the
filing hereof:
Snelbaker, Brenneman & Spare, P. C. -legal fees and costs advanced
to 4/24/02:
M. Shields - payment of family exemption:
Reserve for miscellaneous legal expenses, accounting expenses and
filing fees:
TOTAL, PERSONALTY, PRINCIPAL ACCOUNT, CREDITS:
PERSONALTY - INCOME ACCOUNT
DEBITS
The Accountant charges himself with receipt of the following items of
income from personalty:
LAW OFFICES
SNELBAKER.
BRENNEMAN
Be SPARE
PNC Checking Account No. 5000998192, interest posted/earned
from date of death to close of account:
TOTAL, PERSONALTY, INCOME ACCOUNT, DEBITS:
-3-
224.81
2,422.50
40.00
19.39
1,780.31
271. 00
13.60
3.35
22.00
357.00
2,389.50
1,641.40
3,500.00
1.000.00
$21.654.25
$8.52
$8.52
PERSONALTY - INCOME ACCOUNT
CREDITS
The Accountant claims credit for payment of the following items from
personalty income:
Commonwealth of Pennsylvania, 2001 income:
$ 15.94
U. S. Treasury, 2001 Federal Income Tax:
859.00
TOTAL, PERSONALTY, INCOME ACCOUNT, CREDITS:
$874.94
REAL ESTATE - PRINCIPAL ACCOUNT
DEBITS
The Accountant charges himself with receipt of the Decedent's real
estate as follows:
Condominium Unit known as 552 Brighton Place, Mechanicsburg,
as described in Cumberland County Deed Book 173, Page 50
Sales Price:
$123,900.00
$123.900.00
TOTAL, REAL ESTATE, PRINCIPAL ACCOUNT, DEBITS:
REAL ESTATE - PRINCIPAL ACCOUNT
CREDITS
The Accountant claims credit for payment of the following items
from real estate principal:
LAW OFFICES
SNELBAKER.
BRENNEMAN
Be SPARE
L. G. Connor Appraisers - appraisal fee
S. H. Black & Son - repairs to condominium
Brighton Place - condominium fees (November, December)
Waste Management of Central PA (October, November)
PP&L Electric (August - November)
United Water Pennsylvania (September - November)
Comcast - final payment on account
275.00
10,221.91
136.00
19.84
91.57
34.14
5.22
-4-
Verizon - payment on account
AT &T Consumer Lease Services - payment on account
Brighton Place Condominium fee (January - March)
United Water Pennsylvania (December - April)
PP&L Electric
Upper Allen Township - sewer charges
Settlement costs on sale of Real Estate:
Transfer tax
Sewer charges:
Notary fee: Tax certification:
Homeowner's dues
2002 County Real Estate Taxes
Resale Certificate fee:
Processing fee to Re/Max
Sales Commission to Re/Max
$1,239.00
115.56
14.00
68.00
312.24
50.00
195.00
7.434.00
Total:
TOTAL, REAL ESTATE, PRINCIPAL ACCOUNT, CREDITS:
REAL ESTATE - INCOME ACCOUNT
DEBITS
The Accountant charges himself with receipt of the following income
from real estate:
Credit for prorated items upon sale of real estate:
County Real Estate Taxes
School Taxes:
April Condo fee:
$223.03
283.90
35.17
Total:
Refunds, AT&T
LA W OFFICES
SNELBAKER.
BRENNEMAN
Be SPARE
TOTAL, REAL ESTATE, INCOME ACCOUNT, DEBITS:
-5-
58.98
19.46
204.00
49.95
281. 78
200.00
9.427.80
$21.025.65
$542.10
33.44
$575.54
LAW OFFICES
SNELBAKER.
BRENNEMAN
& SPARE
REAL ESTATE - INCOME ACCOUNT
CREDITS
The Accountant claims credit for payment of the following items from
real estate income:
TOTAL, REAL ESTATE, INCOME ACCOUNT, CREDITS:
-6-
NONE
NONE
- __u __u __ __
LAW OFFICES
SNELBAKER.
BRENNEMAN
Be SPARE
I. PERSONALTY
A. PRINCIPAL ACCOUNT
Debits
Net Gains/Losses
Sub- Total
Credits
Balance
B. INCOME ACCOUNT
Debits
Credits
Balance
RECAPITULATION
$18,892.71
575.69
19,468.40
(21.654.25)
$ 8.52
874.94
C. NET BALANCE OF PERSONALTY:
II. REAL ESTATE
A. PRINCIPAL ACCOUNT
Debits
Credits
Balance
B. INCOME ACCOUNT
Debits
Credits
Balance
$ 123,900.00
21.025.65
$ 575.54
-0-
C. NET BALANCE OF REAL ESTATE:
III. NET BALANCE OF ESTATE FOR DISTRIBUTION:
-7-
$(2,185.85)
$(866.42)
$(3,052.27)
$102,874.35
$575.54
$103.449.89
$100.397.62
SCHEDULE OF PROPOSED DISTRIBUTION
1. To: MARIETTA SHIELDS on account of Spousal Election
pursuant to 20 Pa.C.S.A. S 2210(a):
$ 33,131.21
2. To: RANDALL A. SHIELDS as per Item 2 of Decedent's Will:
Furniture/furnishings received in kind: $510.00
Cash: $66.756.41
$ 67.266.41
TOTAL DISTRIBUTION:
$100.397.62
LAW OFFICES
SNElBAKER.
BRENNEMAN
a: SPARE
-8-
STATE OF MARYLAND
COUNTYOF ~
)
: SS.
)
RANDALL A. SHIELDS, being duly sworn according to law deposes and says: that he is
the Executor of the Estate of PAUL J. SHIELDS, Deceased and the Accountant herein; that the
foregoing Accounting is true and complete; that the attached list or schedule [*] contains the
names and addresses of all persons who have given notice of their claims, and whose claims
remain unpaid; that the attached list or schedule [**] contains the names of all persons interested
in the distribution of said Estate; and that the facts set forth in the within Account are true and
correct to the best of his knowledge, information and belief.
R~- - ~-~\\.~ .g.~~~ \
Randall A. Shields, Executor
(SEAL)
My Commission Expires
May 1, 2005
* Persons havin~ claims against Estate:
None
** Persons interested in distribution of Estate:
Randall A. Shields
2 Skywood Court
Baltimore, MD 21234
Marietta Shields
Room 107, Seidle Hospital
120 S. Filbert Street
Mechanicsburg,PA 17055
Cumberland County Assistance Office
c/o Linda Hasco
P. O. Box 599
Carlisle, PA 17013-0599
-9-
///)_/9-/
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRIS8URG, PA 11128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*
REV-U07 EX AFP (01-02)
"()2
JUl -1
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
:05 COUNTY
ACN
06-24-2002
SHIELDS
10-10-2001
21 01-1013
CUMBERLAND
101
PAUL
J
KEITH 0 BRENNEMAN ESQ
SNELBAKER ETAL
44 W MAIN ST
MECHANICSBURG
Allount Re..itted
C
PA 17J5~rnL
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLEI PA 17013
NOTE: To insure proper credit to your accountl subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REY:ii;b-j-ix-AFP--i'lif:ozi-------...-iNiiERi'TANC'E-TAX-STA-iEMENT-'(fF'-Accouiii--.-..--------------- --- - --
ESTATE OF SHIELDS PAUL J FILE NO.21 01-1013 ACN 101 DATE 06-24-2002
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 DUEl APPLICATION OF ALL PAYHENTSI THE CURRENT BALANCEI ANDI IF APPLICABLE I
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 06-17-2002
P R I NC I PAL TAX DU E : ...........................................................................................................................................................................................................................
91251.11
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
01-07-2002 CDOO0723 462.56 81850.00
03-18-2002 REFUND .00 71.36-
05-24-2002 CDOO1211 .00 10.44
TOTAL TAX CREDIT 91251.64
BALANCE OF TAX DUE .53CR
INTEREST AND PEN. .00
. IF PAID AFTER THIS DATEI SEE REVERSE TOTAL DUE .53CR
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $11
NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRll
YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. l
v
v
STATUS REPORT UNDER RULE 6.12
Name of Decedent: Paul J. Shields
Date of Death: October 10, 2001
Will No.
Admin. No. 21-01-1013
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 X 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 X No
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 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.
Date: June 26. 2002
IjJn~
Signature
r-
I
_J
::-.:J
-----:;
Keith o. Brenneman
Name (Please type or print)
44 W. Main Street
Mechanicsburq, PA 17055
Address
:....,.......,
. .
t';-;
to" i
c:3
(7171 697-8528
Te 1. No.
',(" ~
--" ....~_...
Capacity:
Personal Representative
x Counsel for personal
representative
(MAH: rmf / AM) )
17- /9- /
~~ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 11128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
KEITH 0 BRENNEMAN ESQ
SNELBAKER ETAL
44 W MAIN ST
MECHANICSBURG
'02
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
() "") 'r\r~COUNTY
, , '.I-'ACN
06-17-2002
SHIELDS
10-10-2001
21 01-1013
CUMBERLAND
101
JUI\J 21
*
REV-1S~7 EX AFP (01-02)
PAUL
J
\J~' :.
PA 17o!i~nt,
Allount Rellitted
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-Y=iS4-j-EX-AFP-fol-':oz-f-NoT"icE--oF-'Z-NHE;fiTiifcE-T"Ax-jrppRjrisEMENT-,--AL'LowiNCE-oii-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SHIELDS PAUL J FILE NO. 21 01-1013 ACN 101 DATE 06-17-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ 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 CREDIT~~
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. Hartgages/Notes Receivable (Schedule D) (4)
5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
NO. 01
.00
.00
.00
.00
347.88
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Hisc. Expenses (Schedule H) (9)
10. Debts/Hortgage Liabilities/Liens (Schedule I) (10)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequestsj Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subiect to Tax
.00
.00
lll)
ll2)
ll3)
ll4)
NOTE:
71,759.53 X 00 =
205,580.09 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.
347.88
no
347.88
.00
277,339.61
ll9)=
.00
9,251.11
.00
.00
9,251.11
-
r"rnl::nl K~I;~~"'I l+J AHOUNT PAID
DATE NUHBER INTEREST/PEN PAID (-)
01-07-2002 CDOO0723 462.56 8,850.00
03-18-2002 REFUND .00 71.36-
PAYMENT MUST BE MADE BY 07-10-2002*. TOTAL TAX CREDIT 9,241.20
BALANCE OF TAX DUE 9.91
INTEREST AND PEN. .00
TOTAL DUE 9.91
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
J
.
REV-15oo EX (&<lO)
c......
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
w
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~:$lI)
oD::~
wc..o
J:oo
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c..1D
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FILE NUMBER
21_01
o 1 013
COUNTY COOE YEAR
-----
NUMBER
SOCIAL SECURITY NUMBER
188 - 12
I-
Z
W
o
W
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o
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Shields, Paul J.
DATE OF DEATH (MM-DD-YEAR)
10/10/2001
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
3440
DATE OF BIRTH (MM-DD-YEAR)
05/18/1922
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
Shields Marietta
~ 1. Original Return
D 4. limited Estate
~ 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (date of death after 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copy ofTrust)
D 10. Spousal Poverty Credit (dete of death belween 12-31-91 and 1-1-95)
D 3. Remainder Return (date of death prior 10 12-13-82)
o 5. Federal Estate Tax Return Required
JL 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach SchO)
COMPLETE MAILING ADDRESS
NAME . .
Ke1th o. Brenneman, Esqu1re
FIRM NAM~If.APPli~ble)
SneinaKer, Brenneman & S are, p.e
TELEPHONE NUMBER
(717) 697-8528
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 Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8, Total Gross Assets (total lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
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)
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14. Net Value Subject to Tax (line 12 minus line 13)
44 W. Main Street
Mechanicsburg, PA
17055
(1)
(2)
(3)
(4)
(5)
111,500.00
::J(';;
~ ~~:;
3~
(;""
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~
:rJ?t'
(~1 <'":
C" (~
18,544.83
L..
~
(6)
N
N
(7)
125.593.10
" '
(8)
255,637.93
(9)
(10)
26,514.32
465.29
(11) 26,979.61
(12) 228,658.32
(13)
(14) 228,658.32
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
34,011.52
194,646.80
x.O L (15)
x .O..!? (16)
-0-
8,759.11
z
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~
.-
::)
0..
:E
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u
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15. Amount of line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
x .12 (17)
x .15 (18)
(19)
8,759.11
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
20.@
Decedent's Complete Address:
STREET ADDRESS
552 Brighton Place
CITY 1 . b ~q I STATE PA I ZIP 17055
MeClanlCS ur
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
8,850.00
437.95
Total Credits (A + B + C ) (2)
9,287.95
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E ) (3)
4. If Line 2 is greater than line 1 + line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
528.84
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.
(5)
(5A)
B. Enter the total of line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes
a. 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.......................................................................................................................... D
d. receive the promise for life of either payments, benefits or care? ...................................................................... D
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
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ ~
No
00
00
lXI
lXI
[iI
[iI
D
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YC J ~IU;. f COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of pe~ury. I declare that I have examined this retum, including accompanying schedule, and stalemee,ts, and 10 the pest 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 ~leparer has any knowledge.
DATE
IGo ~, 0"'1-
SIGNAT~ PERSON RESPONSIBLE FOR FILING RETURN
l::s:'o...~... OQ .A-.e;~..'-~ Executor
ADDRESS
25 Court, Baltimore, MD 21234
SIGNAT R THAN REPRESENTATIVE
-DATE
Vi/J/, 1'- 2.0' l...
ADDRESS
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. ~9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 PS. ~9116 (a) (1.1) (ii)J.
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. 99116(a)(1.2)).
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, 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.,502EX' (1.97) (I)
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Paul J. Shields 21-01-1013
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged
between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with
right of
survivorshiD must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
Condominium un~t known as 552 Br~ghton Pl.ace,
Upper Allen Township, Cumberland County,
Pennsylvania, more fully described in Cumberland
County Deed Book 173, Page 50, Appraised Value:
VALUE AT DATE
OF DEATH
$111,500.00
TOTAL (Also enter on line 1, Recapitulation) $ 111,500.00
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX '(1-97) (I)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Paul J. Shields
FILE NUMBER
21-01-1013
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. First Union Securities, Account No. 7963-7005
A. Money Market:
B. Pioneer Midcap Value Fund:
Total:
$1,096.00
4,694.11
$5,790.11
2.
Miscellaneous personal furnishings, furniture and
property:
510.00
3.
PNC Bank Account No. 5000099819~checking):
12,244.72
TOTAL (Also enter on line 5, Recapitulation) $ 18 , 544 . 83
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX + (1-97) (I)
SCHEDULE G
INTER.VIVOS TRANSFERS &
MISC. NON.PROBA TE PROPERTY
ESTATE OF
Paul J. Shields
FILE NUMBER
21-01-1013
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ITEM
NII~ARi=R
1.
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
% OF DEeDS
INTEREST
DESCRIPTION OF PROPERTY
INCLUOE THE NAME OF THE TRANSFEREE. THEIR RELATlOOSHIP TO DECEDENT AND THE DATE OF TRANSFER
ATIACH A COPY OF THE DEED FOR REAl. ESTATE.
DATE OF DEATH
VAllJF OF A!,;!,;FT
First Union Securities; Paul Shielc s
IRA Account No. 7164-3092. Transfc r
to son, Randall A. Shields, named
beneficiary upon death ; 163,704.60
2.
1993 Mercury Sedan, VIN
2MELM75WXPX607833
Transferee: Marietta Shields,
surviving spouse. Decedent and
spouse owned vehicle as tenants
by the entireties since 1994.
100%
1,200.00 50%
*Insurance proceeds payable to
account upon death of account owne
EXCLUSION
IF 'Da 'NO' d
TAXABLE VALUE
38,111 50*
125,593.10
100%
-0-
TOTAL (Also enter on line 7, Recapitulation) $ 125, 593 . 10
(If more space IS needed, insert additional sheets of the same size)
'"""0'"'''' '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Paul J. Shields
FILE NUMBER
21-01-1013
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
1.
B.
1.
2.
3.
4.
5.
6.
7.
DESCRIPTION
FUNERAL EXPENSES:
Nickel Funeral Home - funeral expense
Rev. Julie Hart - honorarium for serVlce
St. Paul's Church and Social Committee - service
and funeral luncheon
ADMINISTRATIVE COSTS:
Personal Representative s Commissions
Name of Personal Representative (s)
Social Security Number(sll EIN Number of Personal Representative(s)
Street Address
City
State
Zip
Year(s) Commission Paid:
Attomey Fees to Snelbaker, Brenneman & Spare, P. c.
Family Exemption: (If decedent s address is not the same as claimant s, attach explanation)
Claimant Marietta Shields
Street Address Room 107, Seidle Hospital 120
City Filbert St. Mechanicsbur%tate PA Zip
survivinq spouse
S.
17055
Relationship of Claimant to Decedent
ProbateFeesi spousal election filing fee:
Accountants Fees, miscellaneous probate expenses; filing
fees, reserve
XQli~e~j(IXj~<<s!n~K.
Advertise Letters Testamentary:
A. The Patriot News Co.
B. Cumberland La\l Journal
Total:
L.G. Connor Real Estate Appraisers, Ltd. - real
estate appraisal
Chuck Bricker, Auctioneer - appraisal of personalt)
S.H. Black & Son - repairs to and maintenance of
Estate real estate
$96.81
75.00
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
AMOUNT
$6,552.60
200.00
1,000.00
3,500.00
3,500.00
53.00
1,000.00
171.81
275.00
40.00
10,221.91
$ 26,514.32
Schedule H - Funeral Expenses and Administrative Costs
Estate of Paul J. Shields
File No. 21-01-1013
Item Number B.3.
Family Exemption Explanation
Decedent's surviving spouse, Marietta Shields has a separate address due to the length of
her hospitalization. She continues to undergo medical treatment and requires assistance due to a
partial amputation of her leg.
REV-15" EX '(1-97) (I)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Paul J. Shields
FILE NUMBER
21-01-1013
Include un reimbursed medical expenses.
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
9.
DESCRIPTION
Waste Management of Central PA - payment on accoun
- trash removal service
AMOUNT
19.84
PP&L Electric - payment on account - electric
utility service
91.57
Uni ted Water, PA - payment on account - water
service
49.08
Comcast - payment on account - cable service
5.22
Verizon - payment on account - telephone service
58.98
AT&T Consumer Lease Services - payment on account
19.46
pinnacle Health Hospital - payment on account -
medical expense
19.39
William R. Shields - labor and mileage
101.75
Upper Allen Township - sewer charges
100.00
TOTAL (Also enter on line 10, Recapitulation) $ 465 . 29
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX + (1-97) (I)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Paul J. Shields
NUMBER
I.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1.
Randall A. Shields
2 Skywood Court
Baltimore, MD 21234
Marietta Shields
Room 107, Seidle Hospital
120 S. Filbert Street
Mechanicsburg, PA 17055
FILE NUMBER
21-01-1013
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not List Trustee(s) OF ESTATE
Son Residue of Estate
Surviving
Spouse
Spousal Election:
1/3 of net probate
Estate
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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
SNELBAKER.
BRENNEMAN
a SPARE
LAST WILL AND TESTAMENT
OF
PAUL J. SHIELDS
I, PAUL J. SHIELDS, of Upper Allen Township, Cumberland
County, Pennsylvania, being of sound and disposing mind, memory
and understanding, do hereby make, publish and declare this as
and for my Last will and Testament, hereby revoking and making
void any and all wills by me at any time heretofore made.
1. I direct that all my debts and funeral expenses be paid
as soon as practical after my death by my Executor hereinafter
named.
2. All the rest, residue and remainder of my estate, real,
personal and mixed, and wheresoever the same may be situate,
I give, devise and bequeath to my son, RANDALL A. SHIELDS.
Should my son, RANDALL A. SHIELDS, predecease me, I
give, devise and bequeath all the rest, residue and remainder of
my estate, real, personal and mixed, and wheresoever the same may
be situate, in equal shares to my grandson, WILLIAM R. SHIELDS,
and my granddaughter, JACLYN L. SHIELDS.
4. I hereby nominate, constitute and appoint my said son,
RANDALL A. SHIELDS, as Executor of this my Last will and
;'estament. I further direct that no person serving as Executor
',eunder shall be required to post any bond to secure the
I , !chful performance of his duties in the Commonwealth of
Pennsylvania or in any other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to
SNELBAKER.
BRENNEMAN
a SPARE
this my Last Will and Testament written on Two (2) pages this
18th. day of september, 1997.
~-<-A..lk ,,) ..-f IfJL'c!.-(SEAL)
Paul J. shields
Signed, sealed, published and declared by PAUL J. SHIELDS,
the Testator above named, as and for his Last will and Testament,
in our presence, who, in his presence, at his request, and in the
presence of each other, have hereunto subscribed our names as
attesting witnesses.
K~
(SEAL)
~JJJ C~/ :A p}ySEAL)
-2-
".'-,
/-
L"'W OFFICES
SNELBAKER.
BRENNEMAN
a SPARE
.
r-.
COMMONWEALTH OF PENNSYLVANIA)
SS.
COUNTY
OF
CUMBERLAND)
We, PAUL J. SHIELDS, KEITH O. BRENNEMAN, ESQUIRE and SUSAN
L. ZYCH, the Testator and the witnesses, respectively, whose
names are signed to the attached or foregoing instrument, being
first duly sworn, do hereby declare to the undersigned authority
that the Testator signed and executed the instrument as his Last
Will and Testament and that he had signed willingly, and that he
executed it as his free and voluntary act for the purposes
therein expressed, and that each of the witnesses, in the
presence and hearing of the Testator, signed the Will as witness
and that to the best of his or her knowledge the Testator was at
that time eighteen years of age or older, of sound mind and under
no constraint or undue influence.
~~t:YJ~
tie:;;;;
-J,~I"- ;;( ~Ji
w~tne
Subscribed, sworn to and acknowledged before me by PAUL J.
SHIELDS, Testator, and subscribed and sworn to before me by
KEITH O. BRENNEMAN, ESQUIRE and SUSAN L. ZYCH, witnesses, this
18th day of September, 1997.
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Notary PUblic
Notarial Seal
Palrltla J. Thomson, Notal'{ PublIc
Mecl1..lcsburg BolO, eombe<1and CountY
My CommIsSion Expires Dec. 31, ,996
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