HomeMy WebLinkAbout11-18-05
CHARLES E. SHIELDS, III
ATTORNEY-AT-LAW
6 CLOUSER ROAD
Corner ofTrindk and Clouser Roads
MECHANICSBURG. PA 17055
GEORGE M. HOUCK
(1912-1991)
TELEPHONE (717) 766-0209
FAX (717) 795-7473
November 18, 2005
Register of Wills
Cumberland County Court House
1 Court Square
Carlisle, P A 17013
Re: Estate of Doris L. Stone
No. 21-05-0095
Dear Register of Wills:
Please find enclosed for filing 2 copies ofthe Inheritance Tax Return for the Doris L.
Stone Estate as well as Check No. 532, in the amount of$15.00 for the filing fee, Check No.
533, in the amount of$125.00 for additional probate, and Check No. 534 in the amount of
$2,410.89 for Inheritance Tax due.
Thank you for your kind attention to this matter.
Very truly yours,
~~d.
Charles E. Shields, III
Attorney-At-Law
CES/mjj
Enclosures
REV- t 500 EX (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INIT1AL)
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DATE OF DEATH (MM-DD-YEAR)
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OFFICIAL USE ONLY
FILE NUMBER
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COUNTY CODE
YEAR.
NUMBER
DATE OF BIRTH (MM-DD-YEAR)
~/- 22.- /925
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
,AI/A
I:gJ 1. Original Return
D 4. Limited Estate
IZI 6. Decedent Died Testate (Attach copy of Willi
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 (AttachcopyofTrusl)
D 10. Spousal Poverty Credit (dale of death between 12-31-91 and 1-1-95)
SOCIAL SECURITY NUMBER
,;wI - /6
7/~~
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Return (dale of death prior 1012-13-82)
D 5. Federal Estate Tax Return Required
2.- 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
COMPLETE MAILING ADDRESS
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NAME e /1/1- /l. L E:5 E:
FIRM NAME (If Applicable) AJ/ A
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TELEPHONE NUMBER
7/7- 71?~- OZo'j
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)
~ 'J./3. 000. DO
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(1)
(2)
(3)
(4)
(5)
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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)
(6)
(7)
(9)
(10)
1-'9. i.2.1. S{g
~ 36'(.. 33
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a}(1.2)
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x.oL (15)
x .0 LIS (16)
x .12 (17)
x .15 (18)
(19)
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
20.0
':HECK 4ERE ~ ,,~~> l.RE ~EQUEST'NG r' i~EFIJND 'JF ~N OVERPAYMENT
OFFICIAL USE ONLY
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(11)
(12)
(13)
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(14)
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Decedent's Complete Address:
STREET ADDRESS StJ~ IV- /Jf~...f/(E r .:5,7:
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CITY /}UFt!H/I/JI/Co~U~ 6- I STATE ,:J,f. I ZIP 17r;S$"
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
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~ .:)so. ~p
Total Credits (A + 8 + C )
3. Interest/Penalty if applicable
D. Interest
E. Penalty
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4.
Tolallnterest/Penalty ( 0 + E)
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
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 lax due.
8. Enter the tolal of Line 5 + 5A. This is the BALANCE DUE.
(1)
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(58)
Make Check Payable to: REGISTER OF WILLS, AGENT
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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? .............................................................................................................. 0
3. Did cUlcedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0
4. Did decedent own an Individual RetirementAccount, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ .l:8I
Under penalties of pe~ury, I declare that I have examined this return, including accompanying schedules and statements. and to the best of my knowledge and belief, it is true, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
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ADDRESS-o.rNNIS If.. .:s71JN IE
5 I'EA.rllflMHI ~I'l, i/ItJIUIII6 ~A"/N6S; M /7P()7
SIGNATU OF PRE PARER OTHE AN PRESENTATIVE
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ADDRESS CHA,fLi!!i!S IF. SNIEZDs::DE
(, eLlIISR .16., AlEC!HHHIC'J4QAG, 'A /losS"
DATE
I I -Ii dJ..s-
/7019
DATE
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 valueaf transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)].
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 retum 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)].
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 PS. ~9116(a)(1.3)J. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG. PA 17128-0601
.' REV..1162 EX(11-96)
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RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
SHIELDS CHARLES E III
6 CLOUSER ROAD
MECHANICSBURG, PA 17055
--~----- fald
ESTATE INFORMATION: SSN: 201-16-7144
I
FILE NUMBER: 2105-0095
DECEDENT NAME: STONE DORIS L
DATE OF PAYMENT: 04/11/2005
" '''''''''''''"-'''~)I':'''i'':''''~_
,', 04/09/2005.~.....J
POSTMARK DATE: \...
COUNTY: CUMBERLAND
DATE OF DEATH:" 01/10/2005
NO. CD 005182
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $4,750.00
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TOTAL AMOUNT PAID:
REMARKS:
CHECK# 512
SEAL
INITIALS: JA
RECEIVED BY:
TAXPAYER
$4,750.00
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
"'~."., *'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF .s ..,.-:; , ,- 7'\.-.
rl'/l/c-, ~~/S L.
SCHEDULE A
REAL ESTATE
FILE NUMBER
Z/-~S 9~
All r~al property owned solely or as a tenant in common must be reported at fair market I' . '.
between a willing buyer and a willing seller, neither being compelled to buy or sell both having reasona~~e Ut F~~mark~~alue IS defined as the pnce at which property would be exchanged
survivorshin must be disclosed on Schedule F. ' now ge 0 e relevant facts. Real property which is jointly-owned with right of
ITEM
NUMBER
1.
DESCRIPTION
TiPD (2) ~eD1t loTs ,,? 3- rDund S ;-hw.1e ; n -HIL Th ,';oJ ward
oF -Ilk 'i3Or{) ~ h 1>f tvlecha. n I' c.s b u rzJ, C l.l...m ~ 14M.d (}; UI1 ~ J
PL.-Ilfla.. 'Be.; nA Lf)r~ Nos..3 eutd q. I I3lod<: E, bfl () fJ/CW1 Df
Lot& gnDWf) \bs HersL'H1et" tvl~"lor I stUd pJt:t.t'l Qe"~ te.C.i>r-d-
ed in P}4r1 ~DDk dJ PT 10$ ~" ~ K~r&ers ()ff,'a..
in 41111 fbr StUQ' ~H,~.
'B~;a tltt>te fCU+;(!IA,.,Ia.r~y 4~c.r;bec1 U-t tflaf C.e.rf4~ d~ed
..frr,m J"o..Me5 A-. Ch; Iders aMCi Vida /tJ. Coil: IdU'5, h,'s w;fe~
..Jr. ""Robert L. ~ir>ne a.wt 1>o.....s L. Sh>ne, J.uS LVI'1e J doiee/
A-urust /0,1 /""7 R'IUI' re~~d ffl lJe.ed ~k 6L," v~/.
;)1, / fJ~ r,'p /n I'- satd l?eC0rder'.s t>&'~.
(~ee &fy of ckecl alfack4.
7k Sttd ~~rt 1. ~h/!e /l~/te,ed$2~ ./}"r;.s L_ S/Mc/ W/IRJe-
0/1>>1 qJ,~/ale -/J1-/e J/e.s!etl //1 ~ SP-l",; ~r/s L. Spne.
.oj' Pflehtfi;n PI' ~ 46''> .0/ ~t'~ 6~/H;l1veA/~
;/lc,'q'cdf ~ ~/I/lc,ef ~ ~ e/1~I7Z/Jes_
JlI;d PrtJpt-r't.t w4S 1tanfttllAMd Cot1l1effcJ ~ :re.Hr~ D.
~().nderS MI.! l..;V\dGt k. ~nders, his lVl'k, by deed
Ju"te~ Ju'ly ~cr, ~ooS per Jo.le..s ~(t.e.rl1ellt.
(see (!J)ff pf liXeeuf()rs reed MId or S2if1ent~nt sheet
a -It (l c.h id h ere:ti:) .
VALUE AT DATE
OF DEATH
TOTAL (Also enter on line 1, Recapitulation) $ I if 3,000. 00
(If more space is needed, insert additional sheets of the same size)
- 5 ,...
A. B. TYPE OF LOAN:
, 1.DFHA 2.DFmHA 3. OOCONV. UN INS. 4.DVA 5. DCONv. INS.
U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT
6. FILE NUMBER: 17. LOAN NUMBER:
SETTLEMENT STATEMENT 3762-2
8. MORTGAGE INS CASE NUMBER:
C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked "[POC)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
1.0 3198 (SANDERS 504 N. MARKET.PFDI3762.2111)
D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER:
Jeffrey D. Sanders Estate of Doris L. Stone Commerce Bank/Harrisburg, N.A.
Linda K. Sanders c/o Charles E. Shields, III 4 Lemoyne Drive
501 N. Market Street 6 Clouser Road Lemoyne, PA 17043
Mechanicsburg, PA 17055 Mechanicsburg, PA 17055
G. PROPERTY LOCATION: H. SETTLEMENT AGENT: 23.2048775 I. SETTLEMENT DATE:
504 N. Market Street James D. Bogar Law Offices PA2150
Mechanicsburg, PA 17055 July 29, 2005
PLACE OF SETTLEMENT
One West Main S1.
Shiremanstown, PA 17011
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER:
101. Contract Sales Price 143 000.00 401. Contract Sales Price 143000.00
102. Personal Prooertv 402. Personal Prooertv
103. Settlement Charaes to Borrower (Line 1400) 5743.33 403.
104. 404.
105. 405.
Adiustments For Items Paid Bv Seller in advance Adiustments For Items Paid Bv Seller in advance
106. CountvfTwo Taxes 07/29/05 to 01101/06 199.48 406. CountvfTwo Taxes 07/29/05 to 01/01/06 199.48
107. School Taxes 07/29/05 to 07/01/06 1.252.02 407. School Taxes 07/29/05 to 07/01/06 1 252.02.
108. Assessments to 408. Assessments to
109. Sewer 07/29/05 to 10/01105 67.07 409. Sewer 07/29/05 to 10/01/05 67.07
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 150,261.90 420. GROSS AMOUNT DUE TO SELLER 144,518.57
..
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
201. Deoosit or earnest monev 2.000.00 501. Excess Deoosit (See Instructions\
202. Princioal Amount of New Loan(sl 93.000.00 502. Setllement Charaes to Seller (Line 1400l 2887.47
203. Existina loanlsl taken subiect to 503. Existina 10anlS\ taken subiect to
204. 504. Payoff of first Mortgage
205. 505. Pavoff of second Mortaaae
206. 506. Deoosit or earnest monev
207. 507. (Deoosit disb. as oroceedsl
208. 508.
209. 509.
Adiustments For Items Unoaid Bv Seller Adiustments For Items Unoaid Bv Seller
210. CountvfTwo Taxes to 510. CountvfTwo Taxes to
211. School Taxes to 511. School Taxes to
212. Assessments to 512. Assessments to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PAID BY/FOR BORROWER 95,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 2,887.47
300. CASH AT SETTLEMENT FROM/TO BORROWER: 600. CASH AT SETTLEMENT TOIFROM SELLER:
301. Gross Amount Due From Borrower ILine 1201 150261.90 601. Gross Amount Due To Seller ILine 420l 144.518.57
302. Less Amount Paid BvlFor Borrower (Line 220) ( 95,000.00) 602. Less Reductions Due Seller (Line 520) ( 2,887.47)
303. CASH ( X FROM) ( TO) BORROWER 55,261.90 603. CASH ( X TO) ( FROM) SELLER 141,631.10
OMS NO 2502 026 A'oo.
ACKNOWLEDGMENT OF RECEIPT OF SETTLEMENT STATEMENT l
Borrower: Jeffrey D. Sanders and Linda K. Sanders
Seller: Estate of Doris L. Stone and c/o Charles E. Shields, III
Lender: Commerce Bank/Harrisburg, N.A.
Settlement Agent: James D. Bogar Law Offices PA2150
Place of Settlement: One West Main St.
Shiremanstown, PA 17011
Settlement Date: July 29, 2005
Property Location: 504 N. Market Street
Mechanicsburg, PA 17055
I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and
accurate statement of all receipts and disbursements made on my account or by me in this transaction. I further certify
that I have received a copy of the HUD-1 Settlement Statement.
Estate of Doris L. Stone
12 - : C? JC
Dennis A. Stone, Co-Executor
~~~
Sharon Shoop, a/k/a Sharon K. Shoop
Co-Executor
To the best of my knowledge, the HUD-1 Settlement Statement which I have prepared is a true and accurate account of
the funds which were received and have been or will be disbursed b~ t ndersigned as part of the settlement of this
transaction. n
WARNING: It is a crime to knowingly make false statements to the United States on this or any similar form. Penalties
upon conviction can include a fine and imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section
1010.
p
age2 .
L. SETTLEMENT CHARGES
700. TOTAL COMMISSION Based on Price $ @ % PAID FROM PAID FROM
Division of Commission f1ine 7001 as Follows: BORROWER'S SELLER'S
701.$ to FUNOS AT FUNOS AT
702.$ to SETTLEMENT SETTLEMENT
703. Commission Paid at Settlement
704. to
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Origination Fee % to
802. Loan Discount 2.0000 % to Commerce BanklHarrisburg, N.A. 1,860.00
803. Appraisal Fee to Central Penn Appraisals, Inc. 450.00
804. Credit Report to
805. Lender's Inspection Fee to
806. Mortoage App. Fee to
807. Assumption Fee to
808. Document Preparation
809. Tax Service Fee
810. Administration Fee to Commerce BanklHarrisburg, N.A. 575.00
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From 07/29/05 to 08101105 @ $ 12.916700/day ( 3 days %) 38.75
902. Mortoaoe Insurance Premium for months to
903. Hazard Insurance Premium for 1.0 vears to State Farm Insurance \0- POC $424.00b
904.
905.
1000. RESERVES DEPOSITED WITH LENDER
1001. Hazard Insurance months @ $ oer month
1002. Mortaaae Insurance months @ $ oer month
1003. Coun~lTwpTaxes months @ $ oer month
1004. School Taxes months @ $ oer month
1005. Assessments months @ $ per month
1006. months @ $ oer month
1007. months @ $ per month
1008. Aoo.Escrow Adi. months @ $ oer month
1100. TiTlE CHARGES
1101. Settlement or Closino Fee to
1102. Abstract or Tille Search to
1103. Tille Examination to
1104. Title Insurance Binder to
1105. Document Preoaration to
1106. Notarv Fees to B. Williams .- 8.00
1107. Attorney's Fees to James D. Bogar Law Offices P.O.C.Seller & Buver
(includes above item numbers.l101' 1105 1
1108. Title Insurance to James D. Bonar Law Offices 1 223.75
iincludes above item numbers.l103' 1104 - End.l00-300-8.1 )
1109. Lender's Coverage $
1110. Owner's Coverage $
1111. Closing Protection Letter to Fidelity Nallonal Title 35.00
1112.
1113.
1114. Tax Certification to Barry L. Heckard 5.00
1115. SewerlTrash 3rd Quarter to Borough of Mechanicsburg 96.42
1116.
1117.
1118.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording Fees: Deed $ 39.00; Mortgage $ 68.50; Releases $ 107.50
1202. CiWlCoun~ Tax/Stamos: Deed 1 430.00' Mortaaoe 1 430.00
1203. Slate Tax/Slamos: Revenue Stamos 1 430.00; Mortaaae 1.430.00
1204. Assionment of Mortoaoe
1205. Stipulation vs. Liens Prothonotary
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Survev to
1302. Pest Insoection to
1303. Courier to United Parcel Service 15.33
1304.2005-2006 School Taxes to Barrv L. Heckard Tax Collector #18220519053 1 356.05
1305.
1400. TOTAL SETTLEMENT CHARGES tEnter on lines 103, Section J and 502, Section K 5,743.33 2,887.47
By signing page 1 of \hIS slatement, \he e1gnatories acknowledge receipt ot a completed copy of page 2 of \hIS two pagJ ~b tt.-
""1f 1#17
James ). Bogaft.:aw Offices
Settlerr ent A ent
Certified to be a true copy
g
( 3762.2 1 3762.2/11 )
ADDENDUM TO HUD-l SETTLEMENT STATEMENT
I have carefully reviewed the HUD-l Settlement Statement and to the best of my knowledge and belief, it is a
true and accurate statement of all receipts and disbursements made on my account or by me in this transaction. I
further certify that I have received a copy of the HUD-l Settlement Statement.
:2-
SELLER:
Q --1~
SELLER:
SELLER:
To the best of my knowledge, the HUD-l Settlement Statement which I have prepared is a true and accurate
account of the funds which were received and have been or will be disbursed by the undersigned as part of the
settlement of this transaction.
SE~fNT
::r( 2- 'f (0 S-
DATE:
'\V ARNING: It is a crime to knowingly make false statements to the United States on this or any other similar
form. Penalties upon conviction can include a fine and imprisonment. For details see: Title 18 U.S. Code
Section 1001 and Section 1010.
DOCUFEf
DOCOFKP.VT% 09/~4/~OO~
Tax Parcel Number: /f- 22 -DS"/Cf - 0:;.3
THIS INDENTURE
MADE THIS e2ril day of :Jz~f--
five (2005).
, in the year of our Lord two thousand and
BETWEEN
DENNIS A. STONE and SHARON SHOOP, also known as SHARON K. SHOOP,
Co-Executors of the Estate of DORIS L. STONE, deceased, late of the Borough of
Mechanicsburg, Cumberland County, Pennsylvania, Grantors,
and
JEFFREY D. SANDERS and LINDA K. SANDERS, husband and wife, of the
Borough of Mechanicsburg, Cumberland County, Pennsylvania, Grantees.
WHEREAS, the said Doris L. Stone was vested in her lifetime with title to the premises
hereinafter described, in the Borough of Mechanicsburg, County of Cumberland and Commonwealth of
Pennsylvania; and
WHEREAS, the said Doris L. Stone departed this eal1hly life, testate, on the 10th day of January,
2005, and Letters Testamentary were duly issued to the said Dennis A. Stone and Sharon Shoop, also
known as Sharon K. Shoop, by the Register of Wills of said Cumberland County, docketed to No. 21-05-
0095; and
WHEREAS, the lands herein-mentioned were not specifically devised:
NOW, THEREFORE, THIS INDENTURE WITNESSETH, that the said Dennis A. Stone and
Sharon Shoop, also known as Sharon K. Shoop, Co-Executors, as aforesaid, for and in consideration of
the sum of ONE HUNDRED FORTY-THREE THOUSAND and No/IOO ($143,000.00) DOLLARS,
and other good and valuable considerations, to them in hand paid by the said Grantees, at and before the
ensealing and delivery hereof, the receipt whereof is hereby acknowledged, have granted, conveyed,
bargained, sold, aliened, released, and confirmed, and by these presents, by virtue of the power and
authority in their vested by the Fiduciaries Act of the Commonwealth of Pennsylvania, do grant, convey,
bargain, sell, alien, release, and confirm unto the said Grantees, their heirs and assigns:
ALL those two certain adjacent Lots of Ground situate in the Third Ward of the Borough of
Mechanicsburg, County of Cumberland, Commonwealth of Pennsylvania, bounded and described as
follows, to wit:
LOT NO.1
BEGINNING at a point on the eastern side of North Market Street, extended, said point being at
the dividing line between Lots Nos. 2 and 3, Block E, on the hereinafter mentioned Plan of Lots; thence
along said dividing line in an easterly direction one hundred fifty (150) feet to other lands now or
formerly of Newton W. Hershner and Wilma L. Hershner, his wife; thence along said other lands now or
formerly of Newton W. Hershner and Wilma L. Hershner, his wife, in a southerly direction fifty (50) feet
to the dividing line between Lots Nos. 3 and 4, Block E, on said Plan; thence along said dividing line in a
westerly direction one hundred fifty (150) feet to the eastern side of North Market Street, extended,
aforementioned; thence along the eastern side of North Market Street, extended, in a northerly direction
fifty (50) feet to the point and place of BEGINNING.
BEING Lot No.3, Block E, on a Plan of Lots known as Hershner Manor, which said Plan is
recorded in the Cumberland County Recorder's Office in Plan Book 3, Page 105.
LOT NO.2
BEGINNING at a point on the eastern side of North Market Street, extended, said point being at
the dividing line between Lots Nos. 3 and 4, Block E, on the hereinafter mentioned Plan of Lots; thence
along said dividing line in an easterly direction one hundred fifty (ISO) feet to other lands now or
formerly of Newton W. Hershner and Wilma L. Hershner, his wife; thence along said other lands now or
formerly of Newton W. Hershner and Wilma L. Hershner. his wife. in a southerly direction fifty (50) feet
to the dividing line between Lots Nos. 4 and 5, Block E, on said Plan; thence along said dividing line in a
westerly direction one hundred fifty (150) feet to the eastern side of North Market Street, extended,
aforementioned; thence along the eastern side of North Market Street, extended, in a northerly direction
fifty (50) feet to the point and place of BEGINNING.
BEING Lot No.4, Block E, on a Plan of Lots known as Hershner Manor, which said Plan is
recorded in the Cumberland County Recorder's Office in Plan Book 3, Page 105.
BEING the same premises which James A. Childers and Vida M. Childers, his wife, by their
deed dated August 10, 1967 and recorded on August 11, 1967 in the Cumberland County Recorder's
Office aforesaid in Deed Book "L", Volume 22, Page 660, granted and conveyed to Robert L. Stone and
Doris L. Stone, his wife. The said Robert L. Stone departed this earthly life on November 25, 1972,
whereupon full and absolute title to the said premises vested in the said Doris L. Stone by the laws of the
Commonwealth of Pennsylvania incident to tenancies by the entireties. Her said estate is the Grantor
herein.
SUBJECT, NEVERTHELESS, to the following conditions and restrictions:
1. No building or any part thereof shall be erected or maintained closer than 30 feet to the
curb lines of the streets as shown on said Plan; Street lines as shown being from curb line
to curb line.
2. No single house shall be erected on any lot costing less than $5,000.00 and no double
house costing less than $9,000.00.
3. No business property, of any kind, shall be erected or maintained on any lot as shown on
this Plan.
4. No stable, pigpen, slaughterhouse, cattle yard or any other objectionable or obnoxious
structure shall be erected or maintained on any lot.
5. No structure may be used or occupied as living quarters, temporarily or otherwise, unless
such structure complies with restriction 2 above.
6. All lots must be cleared of weeds in accordance with the City Ordinance.
TO HAVE AND TO HOLD the said messuage or tenement and tract of land, hereditaments and
premises hereby granted and released, or mentioned and intended so to be, with the appurtenances, unto
the said Grantees, their heirs and assigns, to and for the only proper use and behoof of the said Grantees,
their heirs and assigns, forever.
AND THE SAID GRANTORS, Co-Executors, as aforesaid, their successors and assigns do
covenant, promise and agree to and with the said Grantees, their heirs and assigns, by these presents, that
the Grantors have not done, committed any act, matter or thing whatsoever whereby the premises hereby
granted, or any part thereof, is, are, shall or may be impeached, charged or encumbered in title, or
otherwise howsoever.
IN WITNESS WHEREOF, the said Co-Executors of the Estate of Doris L. Stone, deceased,
Grantors herein, have hereunto set their hands and seals the day and year first above written.
Signed, Sealed and Delivered
i1;r~O~~1/
Q~..:.. c;: ....r r C--~- (SEAL)
DENNIS A. STONE, Co-Executor of the
Estate of DORIS L. STONE, Deceased
~P~Ji)
Sh~ ~ (SEAL)
SHARON SHOOP, Co-Ex cutor of the
Estate of DORIS L. STONE, Deceased
~ ~Pcb /jjJ
~\~ \<. ~ ~ (SEAL)
Also known as SHARON K. SH OP, Co-Executor
of the Estate of DORIS L. STONE, Deceased
COMMONWEALTH OF PENNSYLVANIA)
SS:
COUNTY OF CUMBERLAND
)
On this, the ':2.:1 ;f;(day of , A.D. 2005, before me a notary public, in
and for the Commonwealth of Pennsy ania, r1 sonally appeared DENNIS A. STONE and SHARON
SHOOP, also known as SHARON K. SHOOP, known to me (or satisfactorily proven) to be the persons
whose names are subscribed as Co-Executors of the Last Will and Testament of Doris L. Stone, and
acknowledged that they executed the same in such capacity.
IN WITNESS WHEREOF, I hereunto set my hand an official seal.
~(/Y)I)LR d Ltl&0atmD
Notary Public
-f:.-
My commission expires:
(SEAL)
COMM J1I OF PENNSYlVANIA
lorARW. SEAl.
801fNIE L. WlLlIAMS,lorMY PUBUC
S11IREMANSTOWN BORO., CUMBERLAND co.
MY COMMISSION EXPIRES APRllIB 2009
CERTIFICATE OF RESIDENCE
I do hereby certify that the precise and exact post office address ofthe within Grantee is:
<;0 \ ~. vY\a v-loWt S}r<olC:I w\( c~,t.c,bw..t!c ~ 1~C)~
r.&~~Jrnlee
~.1508EX+{'.W) .~
'~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATEOF S7bN'E=: ~~/.S" L.
SCHEDULE E
CASH, BANKDEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
Z/-c)S-?~
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. A-II.C/JDn rSJt16 a} S,:,~ ,f /l.ssl?r/ir/ ,:.4m.r 0/ 'pU'd'N1a/~ ~y
CAue-It .8'''/~r, ~eAbht'er/ ..:Tkne b" 2t!JO$". 7;..r4'/ c:5'Q/~
(~e ci'1aIeH/eJ'It Q~dtu/J
sc,/e pi aan/J'/IJJ;/e D" 3- ;U-~S" G Em'r A-. IIsue/,,, I'){
lIb? .€4$'"/, ~~... {!~rh:rk,,,A 1701$
VIAl' :THIHC.B7' 781/1eo' 002./ oJl/:hu-n cfa'~. Iff!'
(Sa. rekU ~ ~ ~/khkrrerO aiY2zc.ItuI)
.2..
3.
e,ri2NJS &II~ kd; ~. 'IOt)"2..f2.2/" e4ec,K,'''l
(.fee mhtah;~ Ie~r q#a'cheG/ )
~
;; '~.z. ()o
l'
~ ,,~{), 00
,.-
7, Ot!..3. /f3
,
8: 33',Zt9
~
/9.3. tJO
"/ ?9."~
..
I, ZSZ,08'
1'! Go 7 . 07
I, ~.oo
'4'.ID
, /,57
,.
"'J../2,t)O
/f.
/JIM/Ius ht {!ry.hl: pf' .tJe;;/JS,r /I/o. 571'/0 -Lf,3
(~e #a4h;// Ie!fer d~ded')
5".
,.
lis. 7rUS",;! - ,feie"J t?n ~"A41 /;'(!. k /~ ~ '?/)~4
P/:'o-ra.fed reilh.burSeMent, 19t'\ 3a.le (!)f Real E~f-Je tt.J
per scl1eclc.(.le 1+ a-nd gz,ftlement atta..chLd -H,.,Q.~t;,:
A-.) I..,'ne ~~,: &u"'r /7MJ/ T~)as
RJ.} 1..,'"e /.fO 7: S u'lI!)ol ta.:)Ce.s
c.) L.:ne. 409,' 'Sewer
P..,.tilLl '"Re.tu,Yld "n pruYli ILMS ~r ~OMeolOne,,!$ -k.su.rtt-t1ce.
( s.e. pterniLtM re.+u..m YlDh'ce tltrD.Ghe.tl)
PQ..~itA.J rGbA.1a "" phone ("e/~t(!.cJ s-ev-II,'ce
1'4rl.-;.1 'Re;hu1a eM phone r-e.\o..red $Lrvict. 1,;1\
.J V\ S lA..ra..#lc,e Y'e.lo..t"c.d Re~nc/.
*" I..nlo Ne/te: IfBms net ~Jd of '8 /,,'~ku:r !.Jete. uP ho ~; bl-e
vtJ.w. CVIlCl a.t"e fRu.e.~te.. n.cr ; +em j'-z:eeJ. ~ ~ ; ~ c./ ud.ed
-fttm; ly phD /-r;3ra.p hs tU1c1 +& /t'k.
7,
ff.
9.
(0.
TOTAL (Also enteron line 5, Recapitulation) $ ;J 3, 707. ~ 3
(If more space is needed, insert additional sheets of the same size)
Buy & Sell on Commission - Complete Sale Service
93 Tex8co Rd., Mechanicsburg, PA 17055 766-57'85
Personal Property of. D cJ /2..; ~ S70 N c
Address
Sold At Public Sale JV ~ 6 ~ 20 0.)--
Outstanding Total Sa" / (, Lj'L(
Total Checks ~ /~ Cf-, )(~
Total Cash
,
I
Cash After Payout :2 8' ), L~
Expenses
Auctioneer & Clerks I
,/;7-5;60
.
AcIv. Cost ,t2~3: Ou
~_.~
........
~ -~ T
Sale Setup or Help qo ,
Total Expenses ~ 4-1;) ,Of)
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Thank You For Selecting Chuck Bricker, Auctioneer & staff
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SiQNt1Jra at SecClflO ~ or _.lId!llgrw
mE~NI! NlJMIIIOR
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s~ of ()().~/T1lIltat AlllI10nzecl siQIW-
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NOTE: If a co-pl.lrch...r other tt'lan your spouse '8 list.d and you want the title to be listed all 'Joint Tenants.With
I RiOt'll of SurvivorShip' (On dealh of on. owner. lItI. SJo.. to surviving owner.) Cl'feCK HERE O. Otherwise, the title
wIll be i.sued 88 'Tenants '" Common' (On death 0' one Owner. tnterest of deceased owner goes to his/her heirs Or
eSlate). . '.
NO're IF 'flo4li \I&HICUi 18 TO 8& USEtl A8... DAILY RENTAL OfllENl!O Vl!I1lCI..E. CHI!CI( THlS'BtOCf( 0 IF !Il.OCK IS CHEOI<EO. COMPl.ETl'" ANO ATTACH FOAM !Il\l.IL.
.NtlL_I'I.
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DAY
'C A
jlGNATUAE OF PERSON ADMINISTERING OATH
;---
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"flderSJOned .,"re,1lY Hll1k8!J ,'C,pkl'::81l0A :", (~cr1"'~at8 "I ;';tll! Ie) I,toe '..,'111<;1(' ,"~scnberl
haVtl. SIIQlecI t" 11m ancumflrll1'\(;8& fI"d oJher Inqal clalm!l SOl !(}f'l1'1 hOle
r,""
,:GNATURI;. OF ^-"'PllCANT (1A AUTHORIZED S1r3NEA
-:::::"
ION/.TORE OF CC,APPUCANFPll( ':'1-- f,UfHflAIZED SIGNER
If a co-purchasar other than your spousa is listed and you want the titla to
ba listed as "Joint Tenants Wnh Right of Survivorship" (On deeth of ana
owner. title goes to surviving owner.). CHECK HEAEO, OItterwise,' the title
will be issued as "Tenants in Common' (On death of'one,<lwner;interest,'ol
deceased ownsr goes to his/her heirs or estate).
1 ST LIEN DATE:
1 ST LIENHOLDER
STREET
CITY
+ IF NO lIElt"CHECK'
STATE
2lP
FINANCIAL INSTlTUTION NUMBER
... IF NO LIEN, CHECK i=:J
:,:ND LIEN DATE;
"NO LIENHOLDER
. ;TREET
,:lTY
'3TATE
'IP
:':INANCIAL li-lSTITU nON NUMBER
(,\. \ ('f r L
~~~ rf/)'I\..4. e.Jf
'+: CITIZENS BANK
525 William Penn Place
Suite 153-2510
Pittsburgh, PA 15219
March 9, 2005
CHARLES E SHIELDS, III
6 CLOUSER ROAD
CORNER OF TRlNDEL & CLOUSER RDS
MECHANICS BURG, PA 17055
Estate of DORIS L STONE
Date of Death: Jan 10,2005
SSN: 201-16-7144
Dear Sir/Madam:
In accordance with your request, the attached information sheet has been provided in the above decedent's
name as of his/her date of death.
For IL or LC accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please
call 1-888-999-6884.
Sincerely,
~~~
Barbara Richards
Operations Services
e CITIZENS BANK
Account Number 6100628221
Account Title DORIS L STONE
Date Opened 9/17/1999
Account Type Checking
Principal Balance as of DOD $7083.43
Interest from Last Posting to DOD $ .00
Account Balance as of DOD $7083.43
YTD Interest to DOD $ .00
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
Date Joint Ownership Established
LIFE SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
! Total Principal and Accrued Interest
Name of Joint Owner
Date Joint Ownership Established
CERTIFICATES OF DEPOSIT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
Date Joint Ownership Established
Estate of: DORIS L. STONE
Date of Death: 01/10/2005
Social Security Number: 201-16-7144
tv 1st
MEMBERS 1st
FEDERAL CREDIT UNION
.~~
57810 -00
11/22/1978
$948.03
$.23
$948.26
Sharon Shoop, Dennis Stone
01/17/2001 11/22/1978
57810 -04
02/01/2001*
$4,000.00
$.99
$4,000.99
Sharon Shoop, Dennis Stone
02/01/2001 02/01/2001
57810 -41
01/10/1999
$9,670.93
$6.49
$9,677.42
Dennis Stone
01/10/1999
57810 -43
03/09/2001
$8,333.04
$3.16
$8,336.20
None
* Account opened with transfer of funds from 57810-00
M(MBE~S 1ST ~'7DE. ~AL ~REDlT UNION
!~i1t~ d /il-tk
, Denise A. Wolfe /-
Insurance Services Supervisor
February 18, 2005
5000 Louise Drive. P.O. Box 40 . Mechanicsburg, Pennsylvania 17055 . (717) 697-1161 . www:members1st.org
II. c,lO b 711.
05 06 05 06 AUSTIN, TEXAS
'2306 98596624 20092800 130 OS TON
1...111...111....1.1..1.1.1.1..1...1..11 nl.I.II....II....I~ II
DENNIS A STONE
DORIS L STONE DECD
6 CLOUSER RD
MECHANICSBURG PA 17055-9735
P939,176,908
Check No;
Ii"",
23.0.6'98:596624.
PHILA TAX REFUND
1'2/04
24
$****1'9~*00
-:000000 5 ~B-: 'iBS'i662"'SII. 0...0505
I ERIE
~. ~SURANCE .
EXCHANGE
. . Member' Erie Insurance Group
FlUE
.
ERIE INSURANCE EXCHANGE
P.o. BOX 1699 ERIE. PA 16530
NAMED INSURED COpy
CAMCELLATIONNOTI,CE
MAIL DATE
BAL:
08/02/05,
$72.Op CR
CANCELLATION' EFFECTIVE
07/29/05 12.01 AM
POLICY NUMBER Q58 2003650 H
POLICY EFFECTIVE DATE 10/20/04
HOMEPROTECTOR POLICY
STANDARD TIME
NAMED INSURED
111I11111111I111111111.111111.11
ESTATE OF DORIS 'STONE
C 0 SHARON SHOOP
25 HICKORY RD
DILLSBURG PA 17019
AA7646
WE ARE NOTIFYING YOU THAT THE ABOVE POLICY IS CANCELLED AS OF THE CANCELLATION
EFFECTIVE HOUR AND DATE SHOWN ABOVE. IF WE HAVE BEEN ASKED TO PROTECT OTHER
INTERESTS, WE ARE REQUIRED TO ADVISE THEM OF THIS CANCELLATION.
THE REASON FOR THIS ACTION :
REQUEST OF NAMED INSURED - SOLD
PREVIOUS BALANCE
UNUSED PREMIUM
PRESENT BALANCE
$.00
$72.00 CR
$72.00 CR REFUND CHECK ENCLOSED
00686
AA7646
FETR FETROW INS ASSOC LLC
932EXC 6/00
REV-150S EX + (1-97)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
S~AlG/ ..ie>;t!./s L.
Z/~o.s - 9'S-
FILE NUMBER
If an asset was made joint within one year of the decedenfs date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
RELATIONSHIP TO DECEDENT
ADDRESS
A. -PE AI-tI/S A. S ~AI€
B. 5K~.&N A: .sJ{~&?~
c.
.s- ~rrf;hJmon "JJr;
'Bc;/,lI .!j"or;,,~.s-, ~/1 /7 ,t7&)7
;;5 H.I~K..ry #4:
]),'//Shw;t. /lA 17~/9
~#
cJa.utter
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Include nana of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT deed for joinUy-heJd real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. "/z~hf m,;;m8E/?S 1st 1<e.au-1o.r ~/fk.JS A-~. /lb. ~ 9Lf'il. Zk 33.53 ,.
3/'.P9
13. 57?/tJ -~
,4.. d, /D I /J1EA1~ /:1- t....1e SU4/lt5 ~ /Vo. ~ ~ 333.*'7
J. ~ ()OO. 91 33.33
I
g. 573'/{) -()'f
~ '1, '77. I./z. ~
3- A: l~/" /)1~AlJ3BfS 1st- ~i< ..I 1Jr?r;p,s /1 f0,. 5"tJ 1. 138.. 7/
.I
57?/~-'f1 *'
{~(!. niHil"/! k.1fer d ~cA~eI 75> sde4'. E:)
(, Items ef Nol-/u. Jefa.j !"n!! fftJ pr l Jnh-
erita..nu- W wi /I /ge p:tt'd via ,s ::rr'lh.7A'tl
'Kekt'tt ha,vt a.I r'e4d.y been re.fu filed ~ fB..c.
Pe.pt. of Re.venue Ilia. I~+ clQS,S ma.d)
J.f. /!J Io/!ff:/. Series E"E U. S. SoNi njs -:honds (g) f; .".
ek. e See &pies MUi val UahDI1 Cti Icu.I<<'~Df1 :3, f/ ( 8, 00 S-O 1,9otf.oO
a.thtc:.he.el nere.to),
TOTAL (Also enter on line 6, Recapitulation) $ 'I) 3';7. ~i
(If more space is needed, insert additional sheets of the same Size)
5avinll5 Bond Calculator
07/11/2005 04:S11 PM
Value As Of
01/2005
IUpcdittej
1,,':Hefp:1
-...'.<, ')('-'~";'" -,.,.-.,.'.;.....
Bond Info
Series
Denomination
Serial Number
Issue Date
.1
....'
$~ 100
.)
. )
EE Bonds
Add
Results
# Bonds
8
Total Price
$2,000.00
Total Interest
$1,818.00
Total Value
$3,818.00
YTD Interest
$0.00
Issue Interest Next Final
Serial Number Issue Date Series Denom Price Interest Value Rate Accrual Maturity Note
C383781673EE 10/1992 EE $100 $50.00 $51.64 $101.64 4.00% 04/2005 10/2022 l.~eU
R92745320EE 10/1992 EE 200 100.00 103.28 203.28 4.00% 04/2005 10/2022 I"OeI1
R92745321EE 10/1992 EE 200 100.00 103.28 203.28 4.00% 04/2005 10/2022 [De]
D36107692EE 10/1992 EE 500 250.00 258.20 508.20 4.00% 04/2005 10/2022 [Deli
D36107693EE 10/1992 EE 500 250.00 258.20 508.20 4.00% 04/2005 10/2022 10el'l
D36107694EE 10/1992 EE 500 250.00 258.20 508.20 4.00% 04/2005 10/2022 10eU
I
M64953028EE 03/1995 EE 1,000 500.00 268.80 768.80 2.79% 03/2005 03/2025 10'e1i
M53389296EE 10/1992 EE 1,000 500.00 516.40 1,016.40 4.00% 04/2005 10/2022 10811
le end
Note Description
NI Not Issued
NE Not Eligible for Payment
P5 Includes 3-l)1onth interest penalty
MA Matured and Not Earning Interest
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Page 1 of 1
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16 7144
SERIES EE
INTEREST CEASES 30 YEARS
FROM ISSUE DATE
10
1992
7ODORIS L STONE
flfe PGiL
,'10-14-92\
" 'SS3't3 aCT" "
, :
504 N MARKET STREET
MECHANIcsaUR..G FA 17055
OR: SHA RON $'H60P'
03r30D821-0oao;~ 100992001 001 ROS-A
,
,
,
DATING STAMP
"QQ5 3~_a'9296
, . ~ 7 ~ M533Sl12l1bEE
':0000 '10007':07 &OOOS"lJa'l 2 %1.
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201 16 7144
03
1995:
1(;DOR IS STONE
504 N MARKET ST
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201 167144
SERIES EE
INTEREST CEASES 30 YEARS
FROM ISSUE DATE
10
1992:
1f;DORIS L STONE
SD4 N MARKET STREET
lltECHANICSBUR,G. PA 17055
OR SHA RON S:HOOP
031300821-0000. 100992 001' 001 RDS-Al
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,10-14-92\
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IN-TEREST CEASftS30-YEARS "
FROM ISSUEDA.TE'
10
1992
7bOORIS l STONE
504 N MARKET STREET
llIIE tHAN Ie s au RG PA 17055
OR SHARON SHOOP
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SERIES. E.E3
INTEREST CEASES.3Q. YEARS
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L STONE
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INTEREST CEA~ES, 30 YEARS <,~.,.".'1'.'
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10 1992
201 16 7144
7bDORIS l STONE
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504 N MARkET STREij;::--T
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,5Q4 rt MA'RKE TSTREE!".,
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'03T100821-001l0t:,.~Onl190f
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':0000 '1000 ?I:~_,,-~e 1,0 383_?~. '" ~"_
'~~ ~}1!16;l'~
REV-1510 EX. (1-97)
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
2-1-OS- 9S-
ITEM
NUMBER
1.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
L.:..
FILE NUMBER
S7#NE", ~/..S"
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.
DESCRIPTION OF PROPERTY
INClUDE THE NAME OF THE TRANSFEREE, THEIR R8.ATlONSHIP TO DECEDENT AND THE DATE OF TRANSFER
ATTACH A COPY OF THE DEED FOR REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET
%OF
DECD'S
INTEREST
Th.... vent F,'t14YIl.,'41 for L""ther4J1s, V6.r;a.ble
A-"nlAi~ Con/YAct Le 31,3'3''11
(see v'aIUtl'h'on /e.It~r ond bnaKdDWrJ -fr.r;nt
7hI'JJ"~/lt III-~dJ~t:I her~l6).
1-
q, '188,Q7
JD070
EXCLUSION
IF APl'UCASlE I
-D-
TAXABLE VALUE
r: CJ, 98'c?97
(If more space IS needed, Insert additional sheets of the same size)
TOTAL (Also enter on line 7, Recapnulation) - $ 'J I fj 8' ~, '17
~~.
f Thrivent Financial for Lutherans~
4321 N. Ballard Road, Appleton, WI 54919-0001
Phone: 800-THRIVENT (800-847-4836)
E-mail: mail@thrivent.com . www.thrivent.com
Securities offered through
Thrivent Investment Management Inc.,
625 Fourth Ave. S., Minneapolis, MN 55415-1665,
a wholly owned subsidiary of Thrivent Financial for Lutherans.
Member NASD. Member SIPC.
July 22,2005
Charles E Shields III
Attorney at Law
6 Clouser Rd
Mechanicsburg PA 17055
Subject: Contract LC3133997
Dear Charles:
Thank you for writing.
Doris Stone held Variable Annuity contract LC3133997 with Thrivent Financial for Lutherans at the
time of her death. The date of death value on this contract was $9,988.97. The money was in the
subaccounts as follows:
Large Cap Growth Fund $4,383.98
High Yield Fund $1,626.38
Income Fund $2,249.60
Partner International Growth Fund $1,729.01
Please let me know if you have any questions or if I may assist you in any way. You may reach me at
800-847-4836 ext. 4124.
Sincerely,
O~J~
Diane L. Blum
Claims Examiner
Death Claims, Product Services
dlb
cc: F Neverman 1652990
STONE: Doris L deceased, LC3133997; 504729094
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATEOF .s-n,vE; -Zi:?AZ/S
REV-1511~ . (1-87)
.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
2/- as- 9~
L.
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
~-
DESCRIPTION
1.
FUNERAL EXPENSES:
mQ.\pet~; fu.nero.\ HOMe, t>~ lYIe.c-hD..r'\~cs.blAr~
Ja-mes R. c;; I\fr;€l1 1Ir\e.l'Y\oY"~t1-I.s
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
2.
3.
4.
Name of Personal Representative (s) UeM;.s I/: &h,,,e, ~I"DI1 S/'/)";J-
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City
State
Zip
Year(s) Commission Paid:
Attomey Fees Ch4r!t.S E:. .sh"e./~ ;or
Family Exemption: (If decedenfs address is not the same as c1aimanfs, attach explanation)
Claimant K~#G EL/GliJL€
Street Address
City
Relationship of Claimant to Decedent
Stale
Zip
ProbaleFees aMI orl,IAR/ ,SSUt. ,f S/'~rt ee.rt"-h'cCl~S
5. Accountanfs Fees
6.
7.
f-
9,
I".
If.
I~.
/3.
Tax Retum Preparer's Fees -:Jihef B/'Ae-K6;/~ If'; If' IJlod'. l1Iea/,ItI1lC.r b u r!l
-fr,r fJlP ItlI'IA~.I1 ,,;: !Je.n,,,al /P~ .,..~;f ~ ~Nrn5 ;6,. /,uJ' elPO'l
A-t/rt/'f':S/7 ;.;, ~ f4r//.fk S-f!.I/nnel
/l-P/l'vl/S'7 1/1 ~ f"lIlICuhNl kw .hltnlal
A-ddih'~AIlI vi/Pl't eerf;!;ca.ks
.1-,,',1,/'4""/ p""ba~ he
;:;"4; fie ~ Re,iJkr #1 A///h
VR'Il!f ~hu;kg./'11 ~N'/J' Clf;k~kl /R~~ /~'9'0 /'/A?/ ,'nc. keGS, dZ:
" "L. AL d.~ /./_ (~~AM.)
EXjIIIe/lkS" e~. ~A"r/ q .In(ch'A~er {.au~cR prlt:.J'lOCr II
(.sre ~)',41tmi' skd gj/)lcki1'?J-.f~.E;) -/ e,;,"i1~eelJ
AMOUNT
~7, 78".bt)
f. ~ $. "0
tv/lIY"F))
~
7,050,0t)
N~NE'
~
Irs: I)()
.,
I b f. DO
, 115. ZS
~ 7.s: DO
, I .:l. DO
C
I ~ 5', If)
51
Ie; ~o
d
:3 ()o. 00
f ~<fo. DO
TOTAL (Also enter on line 9, Recapitulation) $ I'll f( J'f, S ~
(If more space is needed, insert additional sheets of the same size)
i SeW H I c..-ni'd.
I
! EsT. of S/DI()!:I ~~/J L.
----~----- - -- --~-- --------------- --------------- _ --------------------------------
/ t,j/!u'{"/Jj,Aal c.5"~D,.le~r:b.-b~c~~s. _________._
I
1s:-i--~4/ Ro$faie y;.~_n~6;.t_R~Ja!e.clE.1~gS_C{S l?er-..~tt-kVYlC:-~t shee,t
I
,LflH-ackc{ ~ $c.k~It...
i
-i-_1.) L, E~_ ./l/'f-.~lL.P~l".fi.{=~':,.!_.llt;~lc-a."':~ __. ._..... _
-1- lJ.} l.;ne III ~__.s..~~~1.Tr~~4_=.l!o_Y't>."':f.J.,.-..--~r .lYJechlLt1ic~-'tJ Lf.tJ
_j_~.) L"Y1~ /202 !i~!.tY.!!''!:~.~&__T..~ _
I
_LP) L,'ne /3oLf ::lODS-Zoofl, Sehool 7A.~es
I
/'~l PP/.L
/7, I t{/1;kc/ if)llnr
.~. --- - ... --"---'-' -"-" ----- ...... ----.,.. . . ----.--------....-.--- -'-
1':.l..~~I7Ie,. El1e~?~_m.___
/9. I fJpl L
'---'r-m--
! I
.___.________.__.___ .:z/)~~ ___ L e f f 1':!:.-..-tf1~f!lY_---m-~_;-m-._-.-------- ________.____ m__ ___._
- ----------.- 2{L~----lJ,;r'o/l1---l!t--/}{~~~$il~1_--.-~/lfe.lKre--
.. ;1~.J __ _ Er i e--:fi?.;t{mJ1.~.=_fjl?l!1((2Jlt~~._If1s..Lll'.~)'li::.~________ . .
I
,7J i Lt/fler /Ei'Ji'1'O
. .-. -.~ t.-- ..- - . ..---.- "-.- ",-:..,...1/---.-.-
_.____._.____.___ dr~_+-_~--/f/~---.- _
__.__.._______. --"'.[.-.L- pfJj L..
__________..__._.3"_:.L.__ Un;teJ W(1..tf-l'
~1.' PPI L
~/. fJPI- L
. '~H
"'- -.~.. t?ellllllJJrse.1hent l(!Nrie..f-i!:--~~F1ll;. _t::~;,lJr /ld'~/
- Lfllzoloet}p}tl~ f~'6'ed /)14'/;/Jf5:.- e/? teJhM.)
File /Vo. 'l-/-os- 'Is;'
__. _._ __U.___.__
"-
6:00
Jf
s: DO
~
?~. l{2
'II
II '13&. ~___
11
If:' St..oS
,...
/8'.77
I'
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~
a- S. DO
)I
IS. 99
~
1?7. o-D
~
_ Zt:J2. 0/ '- u__
'If
::l7. IJ{.)
'/5:/.5
I I 3..&'2
~ /3. 58
~J3.~Z
~
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~
4' f.Ol>
Michael J. Malpezzi, Owner · Jeremy J. Shartzer, Funeral Director
8 Market Plaza Way · Mechanicsburg, PA 17055 · Phone: (717) 697-4696
February 4, 2005
Mrs. Sharon K. Shoop
25 Hickory Road
Dillsburg, P A 17019
The Funeral Service for Doris L. Stone
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
1. PROFESSIONAL SERVICES
Services of Funeral Director/Staff
FUNERAL HOME SERVICE CHARGES
SELECTED MERCHANDISE:
Steel Protective Casket
12 ga. Galvanized Steel
Register, Memorial Cards, Ackn.
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED
AT THE TIME FUNERAL ARRANGEMENTS WERE MADE, WE ADV ANCED CERTAIN PAYMENTS TO OTHERS AS AN
ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES.
CASH ADVANCES
Opening Grave
Cemetery Equipment
Newspaper Notices - Local
Clergy/Mass Offering
Certified Copies of the Death Certificate
TOTAL CASH ADVANCES AND SPECIAL CHARGES
SUB-TOTAL
INITIAL PAYMENT / DISCOUNT / CREDITS
TOTAL AMOUNT DUE
J2. - ) 5-- () :;-
ct<::.
,~ l 0 Y>"\ .
i::d:-
~.vtotL
$3545.00
$3545.00
$1795.00
$1395.00
$45.00
$6780.00
$625.00
$110.00
$124.00
$100.00
$50.00
$1009.00
$7789.00
$7789.00
cve.cT
www.malpezzijuneralhome.com
James R. Gingrich Memorials
5243 SimDson Ferrv Road.
Mechanicsburq, PA 17055
(717) 766-5622
~~,
d.-S 11~ R~
~~.f~'
U I /}O / f
Invoice
4/19/2005
Contract# Contract Date Name Salesman:
~
1
~
125485
1/13/2005
Doris Stone
1 Cemetery Inscription
N
Q
~
(J
(
l"'-.
~
~
Order Total:
Payments:
Balance Due:
A finance charge of 11fz% per month (18% annually) will he added after 30 days
Ron Colvin
$95.00
$0.00
- --- --_._~-_._.-._.,_._-
$95.00
REV-1512 EX' (1-97)
ESTATE OF
sn;l1/i:, ~/VS
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
L.
FILE NUMBER
:LI-~s- 9.5"
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
AMOUNT
~ Z I.D.3
1.
Ver i un Lv" re..I us
PPIL
~.
~.
7.
f'.
&,gt!A~1
1.. ~ ff/u' Ene.r'J if
8a,.'J He.e.K4re:1, -r~ ~/leekrJ eo~/ l3t>rDU,/" T-..xt!.s
Ida,.r} HecJ<~~ ?u- ~p,"t" ~
,
Sz. tPS
1l
.:zD.41
~
iZt!. "7
~
~z.2f
'I.
I'IfCI
tI/JI'.fd Ivltkr
3.
5:
..
87.t>CJ
]I
'Tl,',7S
1I
'1.lio
'I.
fEr-,'e L.s uro.nce - bo.J4H.Ge. 0,., Coa..r -:];nsurQ.lf,cc
...,
~ I. 00
/0.
R~tu.nd;~1 Df Dverpo..UJ ProeU"~ T-x / /tu.;t Re-ba.1;. I 2tJ03
(Jee, r~c.~'l't / b:tl/V alfacltt.dJ.
,
IZ/./3
TOTAL (Also enter on line 10, Recapitulation) $ Y fro. 33
(If more space IS needed, Insert additional sheets of the same size)
BUREAU OF INDIV .)UAL TAXES
POBOX 280602
HARRISBURG, PA 1712Il-0602
COMMONWEALTH OF PENNSYL VANIA
DEPARTMENT OF REVENUE
November 07, 2005
1/ lID/OS-
~ .~ .S~ ~ 4J/~ 1/.
-i.e ~~k LJ~
oUU~. I
u,-
DORIS STONE EST
C/O CHARLES E SHIELDS
6 CLOUSER RD
MECHANICSBURG, PA 17055
RE: Docket Number:
Social Security Number:
Amount Due:
403054
201-16-7144
$121.13
Dear Claimant:
This is in reference to the previous letter informing you that you had an overpayment for the 2003
Property Tax/Rent Rebate, which resulted from a cross-match audit of the Property Tax/Rent Rebate records
with Personal Income Tax records. The audit showed that you were issued an erroneous rebate check. In
2005, you were requested to reimburse the Commonwealth in the amount of $121.13
The Department has no record of receiving your payment, nor is there any record that you disagreed with
the original notice. Therefore, the total amount owed to the Commonwealth must be paid
within fifteen (15) days from the date of this notice to avoid having your account forwarded for legal action,
which could result in additional cost to you.
Please forward your payment in the enclosed return envelope. Make your check or money order payable to
"P A De{Jartment of Revenue".
If you are unable to pay the full amount at this time, but would like to arrange a schedule for monthly partial
payments, please contact Sherwood Zirrmlerman at (717) 705-2525, benveen the hours of7:30 a.m. and 3:00 p.m.
If you have any additional questions concerning this matter, please contact me at the telephone number
provided below.
Sincerely,
~~
Anita Bullock, Tax Examiner Supervisor
Property Tax/Rent Rebate Division
(717) 705-5456
Enclosure
~"""."., '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
.57l)Alt::; ~A!/S
L.
FILE NUMBER
2~-~.s-- ?S
AMOUNT OR SHARE
OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
1.
'De-AlP/S;f.. 57#A"E
.5 ~.EJe.s/"II~A/.l>~
~/~/.lVG SF'.R/A/6S,
SeAl
y~
P/I- /7007
~.
Sh'.#/I.oN SHPc;r'
;;s fI/(!.Kb/(,Y R~.
:Z;/,L5.e~H6.", r'A' /7~/7
./)A- [,( G ~7c-,<
Y:t-
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 n. 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)
LAST WILL AND TESTAMENT OF DORIS L. STONE
I, DORIS L. STONE, of the Borough of Mechanicsburg,
County of C1Jmberland and State of Pennsylvania, be lng of sound
and disposing mind, memory and understanding, do make, publish
and declare this my Last Will and Testament.
1.
I direct the payment of all my just debts and funeral
expenses as soon after my decease as the same can be conveniently
done.
2.
I give, devise and bequeath all the rest, residue and
remainder of my estate, of whatsoever nature and wheresoever
s i tua te, to my tHO children, to wi t, Dennis A. Stone and She.ron
K. Shoop, share and share alike.
LASTLY, I nominate, constitute and appoint my two children,
the aforesaid Dennis A. Stone and Sharon K. Shoop, Executors of
this my Last Will and Testament.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
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--:'J day of Fe brue.ry, A. D., 1973.
this
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Doris L. Stone
(SEAL)
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Signed, sealed, published and declared by the above named,
Doris L. Stone, as and f'or her Last Will and Testament, in the
presence of' us, who have subscribed our names hereto as witnesses,
at the request of' said testatrix, in her presence and ln the
presence of' each other.
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