The URL can be used to link to this page

Home My WebLink About04-06-06 REV-15oo EX + (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 t- Z W C w (J w c DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SHELLEHAMER HELEN V. DATE OF DEATH (MM-DD-Year) REV-1500rF / INHERITANCE TAX RE"rtfR RESIDENT DECEDENT OFFICIAL USE ONLY 21 -0500894 COUNTYC05E ---YEAR- - - NU'MB'ER- - SOCIAL SECURITY NUMBER DATE OF BIRTH (MM-DD-Year) 1 99- 0 7 - 1 679 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WillS 09/13/2005 06/28/1919 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) w .... ~ ~(I) (J C:::lI::: wa.(J :x: 00 (J a::..J a.m a. ct N/A 00 1. Original Return o 4. Limited Estate ~ 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received SOCIAL SECURITY NUMBER 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 of Trust) D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) D 3. Remainder Retum (date of death prior to 12-13-82) o 5. Federal Estate Tax Return Required .L 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS MARKA. MATEYA ESQUIRE P.O. BOX 127 FIRM NAME (If Applicable) to- Z W C Z o 0.. (I) W c:: c:: o (J z o t= c( ..J ::) t- o:: c( (J w 0:: z o t= c( t- ::) a. :E o (J >< c( I- 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 (7) 223,906.80 (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) (8) 772,209.57 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 37 ,950.94 10. Debts of Decedent, Mortgage Liabilities. & Liens (Schedule I) (10) 1,771.63 TELEPHONE NUMBER 717 241-6500 (1) (2) (3) (4) (5) BOILING SPRINGS 179,900.00 4,520.43 P 17007 OFFICIAL pSE ONL y--'~". 363,882.34 (6) 0.00 1 ~.......,,~ 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) (11) (12) (13) 39,722.57 732,487.00 503,861.25 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES (14) 228,625.75 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 0.00 X _ (15) 0.00 0.00 X _ (16) 0.00 228,625.75 X .12 (17) 27,435.09 0.00 X .15 (18) 0.00 (19) 27,435.09 20. .0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT >>' .SESURETOANSWERAI..I..QUESTIONSONREVERSE'SIDEAND,RECHECKMATH < < REV-1502 EX + (6-98) '. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER SHELLEHAMER. HELEN V. 21 05 00894 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 sUlVivorship must be disclosed on Schedule F. SCHEDULE A REAL ESTATE ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 179,900.00 108 S. ORANGE STREET CARLISLE, P A SETTLEMENT SHEET ATTACHED TOT At (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 179900.00 REV-1,503 EX + (\>-9. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS FILE NUMBER 21 05 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ESTATE OF SHELLEHAMER. HELEN V. 00894 ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. DESCRIPTION US. SAVINGS BONDS ISSUE DATE - 02/1994 HH SERIES NO. D3594647HH $500.00 DENOMINATION US SAVINGS BONDS ISSUE DATE 02/1994 HH SERIES NO. D03594648HH $500.00 DENOMINATION US SAVINGS BONDS ISSUE DATE 02/1994 HH SERIES NO. D03594649HH $500.00 DENOMINATION US SAVINGS BOND ISSUE DATE 02/1994 HH SERIES NO. D03594650HH $500.00 DENOMINATION US SAVINGS BOND ISSUE DATE 02/1994 HH SERIES NO. D03594651HH $500.00 DENOMINATION US SAVINGS BOND ISSUE DATE 02/1994 HH SERIES NO. D03594652HH $500.00 DENOMINATION US SAVINGS BOND ISSUE DATE 11/1975 E SERIES NO. Q6037390726E $25.00 DENOMINATION US SAVINGS BOND ISSUE DATE 1/1976 E SERIES NO. Q6052615517E $25.00 DENOMINATION US SAVINGS BOND ISSUE DATE 03/1976 E SERIES NO. 06071740669E $25.00 DENOMINATION US SAVINGS BOND ISSUE DATE 06/1976 E SERIES NO. Q6102042359E $25.00 DENOMINATION US SAVINGS BOND ISSUE DATE 08/1976 E SERIES NO. 06109820984E $25.00 DENOMINATION US SAVINGS BOND ISSUE DATE 10/1976 E SERIES NO. 06110232240E $25.00 DENOMINATION US SAVINGS BOND ISSUE DATE 12/1976 E SERIES NO. Q6139614460E $25.00 DENOMINATION US SAVINGS BOND ISSUE DATE 03/1977 E SERIES NO. 06153990832E $25.00 DENOMINATION US SAVINGS BOND ISSUE DATE 05/1977 E SERIES NO. Q6180835637E $25.00 DENOMINATION US SAVINGS BOND ISSUE DATE 07/1977 E SERIES NO. Q6188161668E $25.00 DENOMINATION VALUE AT DATE OF DEATH 395.95 395.95 395.94 395.94 395.94 395.94 134.46 132.12 132.12 131.05 131.03 131.03 130.08 130.08 131.36 129.04 TOTAL (Also enter on line 2. Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 4 520.43 Continuation of REV-1500 Inheritance Tax Return Resident Decedent SHELLEHAMER, HELEN V. Decedent's Name Page 1 21 05 00894 File Number Schedule B - Stocks & Bonds ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 17. US SAVINGS BOND 126.51 ISSUE DATE 10/1977 E SERIES NO. Q6228542799E $25.00 DENOMINATION 18. US SAVINGS BOND 116.34 ISSUE DATE 12/1977 E SERIES NO. Q6228758685E $25.00 DENOMINATION 19. US SAVINGS BOND 116.34 ISSUE DATE 02/1978 E SERIES NO. Q6250567985E $25.00 DENOMINATION 20. US SAVINGS BOND 94.72 ISSUE DATE 05/1978 E SERIES NO. Q6273552115E $25.00 DENOMINATION 21. US SAVINGS BOND 94.98 ISSUE DATE 07/1978 E SERIES NO. Q6283087711 E $25.00 DENOMINATION 22. US SAVINGS BOND 94.98 ISSUE DATE 09/1978 E SERIES NO. Q6293253696E $25.00 DENOMINATION 23. US SAVINGS BOND 94.26 ISSUE DATE 12/1978 E SERIES NO. Q6303704764E $25.00 DENOMINATION 24. US SAVINGS BOND 94.27 ISSUE DATE 01/1979 E SERIES NO. Q6289720922E $25.00 DENOMINATION SUBTOTAL SCHEDULE B 832.40 GRAND TOTAL SCHEDULE B $ 4,520.43 REV-1508 EX + (6-98) . '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SHELLEHAMER. HELEN V. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21 05 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. 00894 ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. DESCRIPTION SOVEREIGN BANK CERTIFICATE OF DEPOSIT NO. 2895519045 SOVEREIGN BANK CERTIFICATE OF DEPOSIT NO. 2895519052 SOVEREIGN BANK CERTIFICATE OF DEPOSIT NO. 3385170760 ORRSTOWN BANK SAVINGS ACCOUNT NO. 706001302 ORRSTOWN BANK CERTIFICATE OF DEPOSIT NO. 5060061630 ORRSTOWN BANK CERTIFICATE OF DEPOSIT NO. 5060062912 ORRSTOWN BANK CERTIFICATE OF DEPOSIT NO. 5060066109 2002 BUICK CENTURY CUSTOM SEDAN KELLEY BLUE BOOK RETAIL VALUE M & T BANK SAVINGS ACCOUNT NO. 015004210919592 MEMBERS 1ST FEDERAL CREDIT UNION REGULAR SAVINGS ACCOUNT ACCOUNT NO. 5832-00 AAA MID-ATLANTIC INSURANCE GROUP POLICY CANCELLATION CHECK NO. 0172762 AAA CENTRAL PENN REFUND OF MEMBERSHIP DUES UNITED CHURCH OF CHRIST HOMES REFUND OF ASSISTED LIVING COSTS FOGLESANGER BRICKER FUNERAL HOME PRE-PAID FUNERAL EXPENSES ACCOUNT HOUSEHOLD PERSONAL EFFECTS SOLD AT AUCTION SEE ATTACHED RECEIPT CITIZENS BANK CERTIFICATE OF DEPOSIT NO. 6245-539612 INCLUDES INTEREST OF $21.63 VALUE AT DATE OF DEATH 35,868.27 32,178.96 50,238.23 4,917.79 11,630.35 83,154.25 7,400.00 10,000.00 27,390.83 2,825.4 7 67.00 9.99 2,854.00 8,982.90 2,422.50 10,421.21 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 363 882.34 Continuation of REV-1500 Inheritance Tax Return Resident Decedent SHELLEHAMER, HELEN V. Decedent's Name Page 2 21 05 00894 File Number Schedule E - Cash, Bank Deposits, & Misc. Personal Property ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 17. CITIZENS BANK 3,934.43 CERTIFICATE OF DEPOSIT - NO. 6245539604 INCLUDES INTEREST OF $8.17 18. CITIZENS BANK 14,024.99 CERTIFICATE OF DEPOSIT NO. 6245-539620 INCLUDES INTERESET OF $29.10 19. CITIZENS BANK 25,043.73 CHECKING ACCOUNT NO. 6205363678 20 CITIZENS BANK 30,174.64 CHECKING ACCOUNT NO. 6100731804 21 ANTHEM BLUE CROSS AND BLUE SHIELD 93.60 CHECK NO. 0060070748 REFUND FOR MEDICAL EXPENSES 22 ANTHEM BLUE CROSS AND BLUE SHIELD 249.20 CHECK NO. 0060070749 REFUND FOR MEDICAL EXPENSES SUBTOTAL SCHEDULE E 73,520.59 GRAND TOTAL SCHEDULE E $ 363,882.34 REV-1510 EX + (6-98) 'w SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SHELLEHAMER. HELEN V. FILE NUMBER 21 05 00894 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 ITEM INClUDE THE NAME OF THE TRANSFEREE, THEIR RElATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST VALUE (IF APPliCABlE) 1. US SAVINGS BOND OWNED BY DECEDENT PAYABLE ON 10,224.00 100. 10,224.00 DEATH TO NANCY L. GROSHEK - SISTER 10,000.00 SERIES I NO. X002040032I 2 US SAVINGS BOND OWNED BY DECEDENT PAYABLE ON 10,224.00 100. 10,224.00 DEATH TO NANCY L. GROSHEK - SISTER 10,000.00 SERIES I NO. X002040031I 3 US SAVINGS BOND OWNED BY DECEDENT PAYABLE ON 10,224.00 100. 10,224.00 DEATH TO NANCY L. GROSHEK - SISTER 10,000.00 SERIES I NO. X0020400301 4 SECURITY FIRST ANNUITY - SINGLE PREMIUM 30,000.00 100. 30,000.00- DEFERRED ANNUITY SISTER IS ANNA M FREY - BENEFICIARY 5 MEMBERS FIRST FEDERAL CREDIT UNION 24,718.11 100. 24,718.11 CERTIFICATE OF DEPOSIT NO. 5832.43 INCLUDES INTEREST OF 24.03 6 MEMBERS FIRST FEDERAL CREDIT UNION 84,571.33 100. 84,571.33 CERTIFICATE OF DEPOSIT NO. 5832-45 INCLUDES INTEREST OF 91.65 7 MEMBERS FIRST FEDERAL CREDIT UNION 10,852.05 100. 10,852.05 CERTIFICATE OF DEPOSIT NO. 5832-46 INCLUDES INTEREST OF 7.95 8 MEMBERS FIRST FEDERAL CREDIT UNION 43,093.31 100. 43,093.31 CERTIFICATE OF DEPOSIT NO. 5832-47 INCLUDES INTEREST OF 52.22 TOTAL (Also enter on line 7 Recapitulation) $ 223.906.80 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (12-99) 'w SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SHELLEHAMER. HELEN V. FILE NUMBER 21 05 00894 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. FOGELSANGER-BRICKER FUNERAL HOME 8,982.90 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees MARK A. MATEY A, ESQUIRE 13,000.00 3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS 580.00 5. Accountanfs Fees 6. Tax Return Prepare~s Fees 7. CUMBERLAND LAW JOURNAL - ADVERTISEMENT OF ESTATE 75.00 8. THE PATRIOT NEWS - ADVERTISEMENT OF ESTATE 206.64 9. S.W. BARRETT REAL ESTATE & APPRAISAL SERVICE 275.00 10. ABOM & KUTULAKIS -INITIAL CONSULTATION (LEGAL SERVICES 198.00 11. CALDWELL BANKER - REAL ESTATE SALES COMMISSION 10,794.00 12. REAL ESTATE TRANSACTION FEE 125.00 13. MARK A. MATEYA, ESQUIRE - DEED PREPARATION 300.00 14. STATE REAL ESTATE TAX STAMP 1,799.00 15. HOME WARRANTY EXPENSE 409.00 16. KAPNER'S CLEANING SERVICE - HOME CLEANING FOR SALE OF REAL ESTAT 42.40 17. ROWE'S AUCTION SERVICE - AUCTIONEER COMMISSION 847.00 18. LINDSEY'S HAULING & DONATIONS - CLEANING & TRASH REMOVAL 225.00 TOTAL (Also enter on line 9, Recapitulation) $ 37870.94 (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent SHELLEHAMER, HELEN V. Decedent's Name Page 3 21 05 00894 File Number Schedule H - Funeral Expenses & Administrative Costs - 87. ITEM NUMBER DESCRIPTION AMOUNT 19. CUMBERLAND COUNTY REGISTER OF WILLS - SHORT CERTIFICATES 12.00 SUBTOTAL SCHEDULE H-B7 12.00 REV-1?12 EX + (0-98) * SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SHELLEHAMER. HELEN V. FILE NUMBER 21 05 00894 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1. VERIZON WIRELESS TELEPHONE SERVICE - FINAL BILL ACCOUNT NO. 819358335-00001 2. PARKERS LAWN GROOMING SERVICE SEPTEMBER LAWN CARE EXPENSE VALUE AT DATE OF DEATH 24.30 127.20 3. H.B. MCCLURE COMPANY INSPECTION OF HEATING SYSTEM IN RESIDENCE INVOICE NO. 294285 4. BOROUGH OF CARLISLE WATER SEWER CHARGES 9/15/05 - 10/15/05 ACCOUNT NO. 06660 5. PARKER'S LAWN GROOMING SERVICE OCTOBER LAWN CARE EXPENSE 125.00 16.18 116.60 6. BOROUGH OF CARLISLE WATER/SEWER CHARGES 10/15/05 - 11/04/05 ACCOUNT NO. 06660 0 7. B.C. & SONS CONSTRUCTION SNOW REMOVAL SERVICE FOR RESIDENCE 16.18 60.00 8. PHARMERICA MEDICAL SUPPLIES 103.17 9. STATE FARM INSURANCE HOMEOWNERS INSURANCE COVERAGE 398.00 10. ABOM & KUTULAKIS LEGAL SERVICES 198.00 11. BOROUGH OF CARLISLE WATER/SEWER CHARGES 16.18 12. PP&L ELECTRIC SERVICE 164.09 13. MOBILEX USA PORTABLE X-RAY SERVICES 32.33 14. DENVER BIOMEDICAL MEDICAL SUPPLIES 374.40 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1.771.63 REV-1~13 EX + (_ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER 4 AMOUNT OR SHARE OF ESTATE 1. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS pnclude outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] NANCY L GROSHEK - 25% of Residual 380 MAIN STREET WELLSVILLE, PA 17365 ANNA M. FREY 127 CUMBERLAND AVE SHIPPENSBURG PA 17257 NANCY L GROSHEK 380 MAIN STREET WELLSVILLE PA 17365 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) NUMBER I. Sibling 167,953.75 2. Sibling 30,000.00 3. Sibling 30,672.00 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIA TE, 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. CUMBERLAND GOODWILL FIRE COMPANY 102 W RIDGE STREET CARLISLE, PA 17013 2. FRIENDSHIP EMPIRE FIRE COMPANY 177 CARLISLE SPRINGS ROAD CARLISLE, PA 17013 3. UNION FIRE COMPANY 35 W. LOUTHER STREET CARLISLE, PA 17013 - 15% of Residual 100,772.25 - 15% of Residual 100,772.25 - 15% of Residual 100,772.25 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) $ 503861.25 Continuation of REV-1500 Inheritance Tax Return Resident Decedent SHELLEHAMER, HELEN V. Decedent's Name Page 4 21 05 00894 File Number Schedule J - Beneficiaries - 2B B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 4. CARLISLE 1ST CHURCH OF GOD - 30% of Residual 705 GLENDALE STREET CARLISLE, PA 17013 201,544.50 SUBTOTAL SCHEDULE J.2B 201,544.50 REV-1500 Discount, Interest and Penalty Worksheet Discount Calculation Total Amount Paid within three calendar months of the decedent's date of death: 1 UOOJtQ Discount: ______9_~Q3 Interest Table Year Days Delinquent Balance Due Interest this time period this year this period ~_~e'-ore~_~1 I~~~-~ 1983 1984 --1~~5 _'H~86 1987 -- ------ L1~88J!!r9JJ1l!1~~~j_ -- ---- '_~_~~2 1993 throuah 1994 --- _199~ throuah 1998 ~~~~ _2_0.00 2001 - - -. - .-. 2002 - - 2003 1---.--- 1--- I t - TOTALS Penalty Calculation If the decedent's date of death was on or before March 31, 1993, insert the applicable amount: Total Balance Due on January 17, 1996: Penalty: " A OF cOpy HELEN V. SHELLEHAMER I, HELEN V. SHELLEHAMER, now domiciled in Cumberland County, Pennsylvania, declare this to be my Last Will. I revoke all other Wills and Codicils that I may have previously made. Article I My just debts and expenses of my last illness, funeral, and administration of my estate shall be paid by my Executor from the principal of my residuary estate as soon as practicable after my death. Article II All inheritance, estate, and succession taxes (including interest and penalties thereon, but not including any generation skipping tax) payable by reason of my death shall be paid out of and be charged generally against the principal of my residuary estate without reimbursement from any person. This provision is not a waiver of any right which my Executor has to claim reimbursement for any such taxes which become payable as the result of any property over which I have the power of appointment. "-. t . .. ". '.~ . -' / ~.#~ . .- .. . r". \'" :, , -,- -. ..';~.~:.~:d'~,~~,::,~,:~~;S-:~~, ~ .',..".. ....1' . '. . , . "" \ ....... .-;..4\......,#,'.~..'..lf:...~.. Article III I give, devise and bequeath my tangible personal property in accordance with any memorandum which I have either handwritten or signed, located with my Will or with my valuable papers and found within 30 days of the probate of my Will. Gifts may only be to persons who survive me or to organizations which exist at my death, and if there is a conflict, the memorandum having the latest date shall govern. To the extent no such memorandum is found, or all of my tangible personal property is not disposed of pursuant thereto, my tangible personal property shall be added to my residuary estate and pass under Article IV hereof. Article IV All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, I give, devise and bequeath to be held in trust for the benefit of my husband, LEO R. SHELLEHAMER, currently of Cumberland County, Pennsylvania, to be held, managed, and administered according to Articles V through VII herein. In the event LEO R. SHELLEHAMER predeceases me or fails to survive me by thirty (30) days, then all the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, I give, devise and bequeath according to the following: A. FIFI'EEN PERCENT (150/0) of my estate to the CUMBERLAND GOODWILL FIRE COMPANY, or its successor(s), of Carlisle, Pennsylvania; B. FIFfEEN PERCENT (150/0) of my estate to the FRIENDSHIP EMPIRE FIRE COMPANY, or its successor(s), of Carlisle, Pennsylvania; _2_ -~'.,1t!~'!W,~,,,,,~~,""l"I';':';':''''.'.\'' ...:; ~, ,': '.:_ ,,' '. .." " ~.,~ ~~tr.,~~I""""l.:.",;; ';,. " .1.'~, . .. .... t. -' 'I t /"" ~~ ,:~...~t?~. ~ ..~~~~":'l..a.:-ol"~' i.....~:;'-: .~"r'" '. ..' '. .J.. ~~,,: I, '" :";",: . ''''.' .', 7"\ . i I i I I , ! r >:1' " _.~..~. c.'." . ::~~'~~'?!.~~~;f~7f~:'J! . -"" . / . c. FIFfEEN PERCENT (15%) of my estate to the UNION FIRE COMPANY, or its successor(s), of Carlisle, Pennsylvania; D. TIDRTY PERCENT (30%) of my estate to the CARLISLE FIRST CHURCH OF GOD, or its successor(s), to be used for the church building fund and for the maintenance of the church; and E. TWENTY-FIVE (250A>>) of my estate to my sister, NANCY L. GROSHEK, of Wellsville, Pennsylvania. However, if NANCY L. GROSHEK does not survive me by thirty (30) days, but leaves descendants who survive me by thirty (30) days, those descendants shall receive, Per Stirpes, the share NANCY L. GROSHEK would have received had she survived me by thirty (30) days. Article V In the event that a Trust is created for the benefit of my husband, LEO R. SHELLEHAMER, by or as a result of any part of this Will, the terms and conditions of the Trust for the benefit of LEO R. SHELLEHAMER shall be as follows: A. To expend and apply so much of the net income and so much of the principal oftbe Trust as the Trustee shall consider advisable for the support, health, and care of LEO R. SHELLEHAMER for the remainder of his lifetime. B. In the event of LEO R. SHELLEHAMER's death, the trust shall terminate, and the remaining income and principal of the trust shall be distributed as follows: a). FIFTEEN PERCENT (150~) of my estate to the CUMBERLAND GOODWILL FIRE COMPANY, or its successor(s), of Carlisle, Pennsylvania; .3. '~\':,~,,,:,'1'''''' :.,".-.~..' ...." . ~.."'J';..~....~~~~l;.'''~'.. ,".. . ...,1 . . f . .--.----.""~7~...:. . " .. v '. .,... ....lr.. .r....I"P':..."'~~~~ ~.~ .. " . ..... . "'.,.:. ". ., ..;- - .......(.- ''l-~~~ ~;~.ix'" r .' ..-.....~ "v ... '. ,., 3' .~.:-:~.~.~~~...:.~.\.~.. ~ I " , t.., , b). FIFfEEN PERCENT (15%) of my estate to the FRIENDSmp EMPIRE FIRE COMPANY, or its successor(s), of Carlisle, Pennsylvania; c). FIFfEEN PERCENT (150;0) of my estate to the UNION FIRE COMPANY, or its successor(s), of Carlisle, Pennsylvania; d). THIRTY PERCENT (300;0) of my estate to the CARLISLE FIRST CHURCH OF GOD, or its successor(s), to be used for the church building fund and for the maintenance of the church; and e). TWENTY-FIVE (250;0) of my estate to my sister, NANCY L. GROSHEK, of Wellsville, Pennsylvania. However, if NANCY L. GROSHEK does not survive me by thirty (30) days, but leaves descendants who survive me by thirty (30) days, those descendants shall receive, Per Stirpes, the share NANCY L. GROSHEK would have received had she survived me by thirty (30) days. c. No beneficiary or remainderman of this Trust shall have any right to alienate, encumber, or hypothecate his interest in the principal or income of the Trust in any manner, nor shall any interest be subject to claims of his creditors or liable to attachment, execution, or other processes of law. Article VI In order to carry out the purposes of the Trust established by this Will for the benefit of LEO R. SHELLEHAMER, the Trustee, in addition to all other powers granted by this Will or by law, shall have the following powers over the Trust estate, subject to any limitations specified elsewhere in this Will: _4_ .: ':'~I~~:;;'~"1 :r,(':.'.:... ''':.' ...-:. , '.", ,I . ~.. ,,~,:,?;:'::,'-i~.:':.~' ~,.'~:~~"", . , .0 t'''I . ._-:-:-,.,..... "',,' V\.... ...~...,..~~t,.~..~.~- .' 1'. . -t . ~ ":.. .: ~~~~~~ ~I.I&\... . '.> '. ~". : ~-. ~ ""~ .':'~~:..;\.:.,~~',. ~ 't\~~' 1'" (a) to retain in the form received and/or to sell either at public or private sale, any real estate or personal property except that which I specifically bequeath herein, (b) to manage real estate, (c) to invest and reinvest in all forms of property without being confined to legal investments, and without regard to the principal of diversification, (d) to exercise any option or right arising from the ownership of investments, (e) to compromise claims without court approval and without consent of any beneficiary, (f) to file fiduciary/income tax returns and pay the tax due for any year for which such a return is required, (g) to make distributions in cash or in kind, or in both, and to determine the value of any such property, (h) to employ any attorney, investment advisor, or other agent deemed necessary by my Executor; to pay from my estate reasonable compensation for all their services, (i) to conduct along with or with others, any business in which I am engaged in or have an interest in at the time of my death, G) to receive reasonable compensation in accordance with their standard schedule offees in effect while their services are performed, and Article VII I hereby appoint my sister, NANCY L. GROSHEK as Trustee of any Trust(s) created in this Will for the benefit of my husband, LEO R. SHELLEHAMER. In the event of the renunciation, death, or inability to act, for any reason whatsoever of NANCY L. GROSHEK, I nominate, _5_ ,<.~,.~. ,~::~~&01~~~).. :~:,::<>.l-:~.:' 'r::~; >:~. .: ,""':""'"'\ ", . _" . 0- ':.--: :~'~E :{~:':j:~~;;~~';0:;;:i(~~' constitute and appoint my friend, VIRGINIA M. MASSEY, of Lancaster, Pennsylvania, successor Trustee of any Trust(s) created in this Will. Article VIII I nominate, constitute, and appoint my sister, NANCY L. GROSHEK, Executrix of my Last Will and Testament. In the event of the renunciation, death, or inability to act, for any reason whatsoever of my Executrix, I nominate, constitute and appoint my friend, VIRGINIA M. MASSEY, successor Executrix of my Last Will and Testament. I direct that my Executrix or successor Executrix be permitted to serve without bond and in addition to those powers granted by law, I grant them power to distribute in cash or in kind, in like or in unlike shares, and to file any qualified disclaimer I could have filed if living. My Executrix or successor Executrix shall receive reasonable compensation for services rendered to my estate. Article IX In addition to the powers conferred by law, I authorize my Executrix or successor Executrix in her absolute discretion: (a) to retain in the form received and to sell either at public or private sale, any real estate or personal property except-that which I specifically bequeath herein, (b) to manage real estate, (c) to invest and reinvest in all forms of property without being confined to legal investments, and without regard to the principal of diversification, (d) to exercise any option or right arising from the ownership of investments, _6_ ~:~: "~~\-~'';':':t;f;;';~;~:;'';:''';'. ,'" . ...:':;;;'~t''t.~t./;:'~:'"'''''' .' ~..... ~.1 · 'r .....7")::.;?:~,..;:c~~\..1~,..;..~~',~... ...;...'.....:. I .'~ '. ;', .~, -<".#::~~ ':~ ,'~ ':.: <~ . ,:::-' . ."., ,,' . . I '-...:, L., .,. " .. ::.-i't ;~:.: ',-"-:-:-:::--:- r, ' ._":.. _. '. ..:, r:. :' _.,' \~ ~~l.~~"":,, :.l , ~ ), 'l ,', L..-- ':':">';".'~~~~l:~;~I=.7!'.' " .. r- , " . . ~ ....,.,., (e) to compromise claims without court approval and without consent of any beneficiary, (f) to file any federal income tax return for any year for which I have not filed such return prior to my death, (g) to make distributions in cash or in kind, or in both, and to determine the value of any such property, (h) to employ any attorney, investment advisor, or other agent deemed necessary by my Executor(s); and to pay from my estate reasonable compensation for all their services, (i) to conduct alone or with others, any business in which I am engaged in, or have an interest in at time of my death, and G) to receive reasonable compensation in accordance with their standard schedule offees in effect while their services are performed. IN WITNESS WHEREOF, I, HELEN V. SHELLEHAMER, hereby set my hand to this my Last Will and Testament, on ~7fL,4 I (J ,2004, at Harrisburg, Pennsylvania. )~~~ t/ ~~~~ HELEN V. SHELLEHAMER In our presence, the above-named HELEN V. SHELLEHAMER signed this and declared this to be her Last Will and now at her request, in her presence, and in the presence of each other, we sign as witnesses. Name Address 2000 Linglestown Rd." Suite 303.. Harrisburg.. P A 17110 2000 Linglestown Rd." Suite 303" Harrisburg" P A 17110 _7_ -~iW:.b")t~......~:"..;:.. " .;;..~~:w..'i' ~.~,~~,...~,;,,(,~.,, ..... /. ..:.....~..:~...~:..t'.' .~..'~ f" .,,'. ...... t* I":'::~, '~.:-..' ,!:r: r-. ,:" \ .-...,.. I' ~~ ~'. ::..~:.. 'r, '~~~.< ~. :',:.:~~;~:~-?1~3~~~1:~;~~~" ~. .. I, HELEN V. SHELLEHAMER, Testatrix, who signed the foregoing instrument, having been duly qualified according to law, acknowledge that I signed and executed this instrument as my Will, and that I signed it willingly as my free and voluntary act for the purposes therein expressed. Sworn to or affinned and acknowledged before me by HELE V. SHELLEHAMER, the Testatrix, on 0 , 2004. J/4 V /t/&-k~lJJll) HELEN V. SHELLEHAMER ... ...... .~. "," " Notmial Seal Marielle F. Hazen, Notary Public City of Harrisburg, Dauphin County My Commission Expires Sept. 23, 2006 We, the undersigned witnesses who signed the foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the Testatrix sign and execute this instrument as her Will; that she signed and executed it willingly as her free and voluntary act for the purposes therein expressed; that each of us in her sight and hearing signed the Will as witnesses, and that to the best of our knowledge, that she was at that time eighteen (18) years or more of age, of sound mind, and under no constraint or undue influence. Sworn to or affirmed and subscribed to before me by and witnesses, on o , 2004. [/)Jk~ ~ ~ Notary Pubhc _8_ Not:uial Seal .Mariell; F.. Hazen, Notary Public City of ::'8I!Isburg, Dauphin County My CommiSSIOn Expires Sept. 23, 2006 _~g~-!:;;:~;:"~:~~.i ,>.~:~?:-.~~::--': .(;.:':: ,;., ;', ~-:r-, ", ,.." '., ...~.>,..:..~.'....:..; ~ . ':.' ~.~~~..:l;.,>~;".':~~'8~~~~;~'0' A. Settiement Statement U.S. Department of Housing and Urban Development B. Tvnp. nf I n:m OMS No 2502.0265 RE V. HUD-1 (3/86\ l. OFH^ 2. DFmH^ 3. DConv. Unins. I 6. File Number I 7. Loan Number 8. Mortgage Insurance Case Number 4 OVA 5. Dc.onv. Ins. . . BLACKJOt-06 1 t 321403 C. Note: This 'orm is furnished to give you a statement of actual setllement cosls. Amounts paid to and by the settlement agent are shown. I TiUeExpress Settlement System lIems marked "(p.o.c.)" were paid outside the closing; they are shown here for information purposes and are not Included in the totals. WARNING: It is a crime to knowingly make false Fs~~~~:r~~~~~~~,~n~~?1 S~ates on this ~r any other S~~f1~~'1~enaltieS upon ..... .. 17'?~ KSC D. NAME OF nORROWER: Jon A. Black --.. -~,. ^ 111 ."". E. NAME OF SELLER: The Estate of Helen V. Shellenhamer ^ nnn F~~' F. NAME OF LENDER: M&T Mortgage Corporation ^ f'\nlH:~~' 1 Fountain Plaza. Post Closinl' 6th Floor Buffalo NY 14203 G. PROPERTY ADDRESS: 108 South Orange Street, Carlisle, PA 17013 Carlisle Borouuh H. SE'ITLEMENT AGENT: P A Real Estate Settlement Services, LLC PLACr. OF SrTfLFMENT' 354 Alexander Sorin!! Road Ste. Carlisle. PA 17013 I SFTI'l r:Mr.1\JT DATF' 01/31/2006 J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: 100 (:Q()C::C:: AM()IIr.JT DUE FROM KI 400 GROSS AMOUNT DUE TO C::~I I ~Q' 101 r.nntr;ld c:.;llpc:. mice 179 900.00 d01 r.nntr~r-t c:.~lpc:. nrir-p 179 900.00 102 Per~nn~1 Prnnprtv 402 ppr~anal Prnnertv 103 narrower {Iinp 1.400' 6 572.35 403 104 404 105 40~ Adiustments for iti'rrl~ Cld;d bv seller in advance . . fur items nairf hv ~pllpr in 106. r.ilvllnwn t~ltPc:. don ":k,I'"".,... t..",,,.. 107_ r.nllntv l~ltP~ d07 108 ~r-hnnl t~ltPc:. 01/31/06 to 06/30/06 753.40 408 01/31/06tn06/30/06 753.40 109. dOCl 110. d10 111 d11 112 d1? 120 GRO~~ AMOUNT nUE= FROM .....1 I.........' Ill"........ 187 225.75 420 GRO~~ AMOllNT DUE TO C::~I I ~R' 180 653.40 200. AMOUNTS PAin RY OR ON BEHALF OF ~ ,.... l\1\/~ .... ~oo KcUUl IONS IN A"~()II~T DUE TO C::I=I I I=Q ?O1 npnnc:.i1 nr p~rnpc:.t mnnpv 5 000.00 ~O1 I=ltr-pc:.c:. .... 202 nf npw In::,"c:. 143 920.00 t;O? ,..h::lrnpc:. .."", 13.485.58 ?O3 t~kpn c:.llhipr.l tn 503 I=llic:.tinn ?04 504_ Pavnff of Firc:.t Mnrto;:loe LQan 205 fin~ 206. .. . i r,~r;tnp Rpnair~ 1.024.00 506 ., . <0 ~pn::lirc. 1 024.00 '07 507 ?OR 508 ?09 50~ Il ilt'!IIIS unoaid hv !;elll:llr II~I s :'\n~iri nv !;elli:~r 210 510 r.itv/tnwn t~xP~ 211 01/01/06tn01/31/06 62.31 511 C01Jntv tallP~ 01/01/06 to 01/31/06 62.31 '1' ~rhnnl t;lYPc:. !'\1? '13 513 21d 51d '15 515. ?1A ~1R '17 517. '18 !'\1R '1~ 519 '20 TOTAL PAID BY/FOR I..U I..........' n/UI-.... 150,006.31 520, TOTAl o~nllr.TION A~A()I INT nlJF ~FLLFR 14 571.89 300 CASH AT SETTLEMENT FROM OR TO ~ fiOO CASH AT SETTL ~"AS::~T TO OR FROM ~FI I F ~ 301 /"!r....r-r- lIinp- 1 70\ 187.225.75 A01 r,rnc:.~ &,m 180 653.40 ~o, t P!;'~ --......... .....:,.1 JVIIUI llinp "0\ 150 006.31 602. Less rprllldinn ..__.._1 ... ;,0\ 14.571.89 303. r.A~H FROM ~ ,......... 1\/\11-.... 37 219.44 603 CASH TO C::~I I ~Q 166.081.51 I "...,...,.,..'t......"'Tr ""'f,r".. .,...,..~ ,....r--', ,.."r'" ..................r-.....-.,'T" ...-, U.S. DEPARTMENT OF HOUSING AND UROAN DEVELOPMENT File Number: DLACKJO 1.06 PAGE 2 SET1LEMENTSTATEMENT RFV I-IlJD.l(1/R6) ~ ... ~vdpm P rintpn -, 17~23 KSC L SETT' ~M~NT - --- PAID FROM PAID FROM 700 TOT At SA' ' COMMISSION based on orice $179.900.00 @ 6.000 - 10 794.00 BORROWER'S SELLER'S -.. . .., '7nn\ .... '",II",,~' FUNDS AT FUNDS AT 701 s 5,422.00 to ERA-NRT, Inc. SETTLEMENT SETTLEMENT 702 S 5.372.00 to Coldwell Banker Homesale Group 701 - - 10 794.00 7nd - Fee to Coldwell Banker / ERA-NRT Inc. 195.00 125.00 V ROO. ITEMS PAYABLE IN CONNECTION WITH LOAN A01 . . . (:'pp OJ,, RO? I o::!n Dic:r:Ol rnt % A01 Annrrli!Orll i= F!F! to M&T Mortqaqe Corooration LR 305.00 R04 - ROS MT D...",t, f"h..,.t,j"''''.J:::'vic:.tinn to M&T Mortqaqe Corooration LR -100.00 ROn - Fee to M&T Mortqaqe Corooration LR 76.00 Em7 Flood Cert Fee to M&T Mortqaqe COrPoration LR 8.00 RnA .... to M&T Mortqaae COrPoration LR 100.00 ROQ ~~p to M&T Mortaaqe Corooration LR 195.00 A10 nnt"/PrAn Fee tn M&T Mortaaae Corooration LR 400.00 R11 goo. ITEMS Ref''' IIocn cY IF=NDER TO BE PAID IN ADVANr.F a01 Inl~r~d From 01/31/2006 fn 02/01/2006 tm$ 22 . 1 7 95 Jrbv 1 Davs LR 22.18 OO? Mortn::!np 'nf:.llr:.nt"C' Prl"millm for tn 903. DrA.,.,;""" for to Erie (P.O.C.> 358.00 Buver Q04 905. 1nnn QJ=~J=RV~~ nF=p()~ITF:n WITH l ENnFR FOR 1 n01 H::t7~rti Inc:.llr~nt"'.p 3 mo ff1J $ 29 . 92 Imn LR 89.76 1 OO? Mnrtn~np InC:I"rlnr~ mo. ((j) $ Imo 100~ r.itv ...rooenv ::tx mo ((j) S Imn 1 00.d - T::l~ 8motnl~ 63 . 18 Imo LR 505.44 1 005 ~ 8 mo fB) S 151 . 7 6 Imo LR 1.214.08 1nnQ A _..._._ to M&T Mortaaae Corporation LR -209.36 0.00 1100. TITLE ~~ & ---- 1101 - fp~ 11 0' Ah<.tr~r:t nr . 1101 _'U 1104 Tillp Ino::.llrrlnrp n1nnF!r 110; - 1106 ., - tn Salzmann Huahes P.C. 10.00 1107 Attornpv'<. fppo::. to Mark Ma teva. Esauire 300.00 linr:llJnp<. \ 11 08 Titl~ IMllr::lnca to Lawvers Title/Central Penn/SH PC 1.258.75 (inr:lucfpc:. ) 11 OQ I~nd~r's r.nvpr::lnp ~ 143 920.00 - 1110 nwnPr'c:. ~ - 179 900.00 - 1.258.75 1111 - tn Lawvers Title/Central Penn 150.00 111? r.ln!'l.ino Prntpr:tion I pttpr to Lawvers Title/Central Penn 35.00 1113 1 ?nn r..nV ANn TRANSFER...... & -.....-- 1?n1 - - 38.50 . Mortnrlnp ~ 64.50 . ~plp~f:.p ~ 103.00 1707 -. nppti ~ 1 799.00 . Mortn:.np ~ 1 799.00 1 ?03 ~t~tp f)ppd S 1 799.00 . Mnrtnrlnp ~ 1.799.00 1'04 1705 ..,omp \I\r.'Irr::lnrv to AON Home Warrantv 409.00 j 1300. .u 11 lNtll SETTL~Mt-N - ,- 1301 - tn Salzmann Huahes. P.C. 20.50 13n? \MrA Fe~ tn Salzmann Huahes P.C. 10.00 1303 - to BIS 35.00 , 13041 ... tn B IS 75.00 \ 1305 to BIS 275.00 / 1~nR -. to Carlisle Borouah 16.18 1. ~n'7 1"\. -'- ...'" to Ka'Dner' s Cleanina Service 42.40 ~/ 1400 TnT AI ~i=TTI CUC"'I'" - ---- 'a"tAr "" Ii"'.... 103~ C__I;",,,, I ........ I:n... C;:prtinn 1(\ 6 572.35 13 ,485.58 ./ I / / ROWE'S AUCTION SERVICE (RH 79L) Bill Rowe (AU 1538L) .."'::.- Ben Rowe (AU 1092L) 2505 Ritner Highway · Carlisle, PA 249-2677 697-4794 249-1978 Bob Rowe (AU 2276L) Dave Rowe (AU 2295L) io Is Action Call "Rowe" For Satisfaction SELLERSNAM " / IA t IJ/ .... /1-fA Vl1f DATE ADDRESS~ ~~/ fQ <;4 ~ ~ OTHER. 5'1?t) --~_j!/ ,.c;- . tue id-~. lip r9t. AUCTION DATE/LOCATION n 3(".$ CLERK % ~ .~ DESCRIPTION OF MERCr~lSE. /h~~~ . ,~-?i(/~,~ /:;./JjfJ~ PHONE 7 0-- t/?...J'-'(J0 / AUCTIONEER % 35 !2S~~.~ ~/(~ . V;Vj~' ~- /; ( ?,:-p; I Commission the Auctioneers to sell the merchandise to the highest bidder by Public Auction. Merchandise to be sold as is & grouped as necessary to obtain bids. I certify that I am the owner or authorized represen- tath~e of the merchandise, goods and or property and have good title and the right to sell and that they are free from all incumbrances. I agree to accept all responsibility for providing merchantable title and for delivery of title to the purchaser. I agree to hold harmless the Auctioneers against any claims of the nature referred to in this agreem~n.7J . / " ~ ffI/ ~~. " " ~.. /f' / ., r J '. , '. I f I /\~ _~ _ _ __ ~ / . " .. X... ~ "' AUCTION SIGNATURE S~LLE S :NATURE ;l. ~:)... ZE / '\. Total Sales (Clerking Tickets Attached) $ Less Sale Expense: 35 % Commission Auctioneer $ .~. / ~ttl7 ~ 0/0 Commission Clerks $ OTHER: TOTAL SALE EXPENSE DEDUCTED $ l~ . \ SELLtis NET $ , 'I \ .I l \. ~,\ ,,) v,-.,-' V ,"" AUCTION SIGNATURE /575 ~ SELLERS SIGNATURE INVENTORY (C(Q)[Pl( Estate of HELEN V. SHELLEHAMER HELEN V. SHELLEHAMER NANCY GROSHEK, EXECUTRIX , Deceased No. 21 05 00894 Date of Death 9/13/2005 Social Security No. 199-07-1679 also known as Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. l!We verify that the statements made in this inventory are true and correct. l!We understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: MARK A. MATEY A 1.0. No.: 78931 Address: P.O. BOX 127 Personal Representative: -11JU~d y?!J$J!7v!? ,1(1~f7 ~1z0U j/.3LO~ / Dated BOILING SPRINGS PA 17007 Telephone: 717-241-6500 Description REAL ESTATE LOCATED AT 108 S. ORANGE STREET CARLISLE, CUMBERLAND COUNTY, PA Value 179,900.00 US SAVING BOND - $500.00 DENOMINATION ISSUE DATE - 2/1994 HH SERIES NO. D3594647HH US SAVINGS BOND - $500.00 SERIES ISSUE DATE - 2/1994 HH SERIES NO. D03594648HH US SAVINGS BOND - $500.00 DENOMINATION ISSUE DATE 2/1994 HH SERIES NO. D03594649HH US SAVINGS BOND - $500.00 DENOMINATION ISSUE DATE 2/1994 HH SERIES NO. D03594650HH US SAVINGS BOND - $500.00 DENOMINATION ISSUEDA TE - 2/1994 HH SERIES NO. D03594651 HH 395.95 395.95 395.94 395.94 395.94 Total 772,209.57 (Attach Additional Sheets if necessary) . .. ~ ~ ~ . NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 Continuation of Inventory HELEN V. SHELLEHAMER 21 05 00894 Page 1 Description of Inventory Description US SAVINGS BOND - $500.00 DENOMINATION ISSUE DATE - 2/1994 HH SERIES NO. D03594652HH US SAVINGS BOND - $25.00 DENOMINATION ISSUE DATE - 11/1975 E SERIES NO. Q6037390726E US SAVINGS BOND - $25.00 DENOMINATION ISSUE DATE 1/1976 E SERIES NO. Q6052615517E US SAVINGS BOND - $25.00 DENOMINATION ISSUE DATE 3/1976 E SERIES NO. Q6071740669E US SAVINGS BOND $25.00 DENOMINATION ISSUE DATE 6/1976 E SERIES NO. Q6102042359E US SAVINGS BOND - $25.00 DENOMINATION ISSUE DATE 8/1976 E SERIES NO. 06109820984E US SAVINGS BOND - $25.00 DENOMINATION ISSUE DATE 10/1976 E SERIES NO. 06110232240E US SAVINGS BOND - $25.00 DENOMINATION ISSUE DATE -12/1976 E SERIES NO. Q6139614460E US SAVINGS BOND $25.00 DENOMINATION ISSUE DATE 3/1977 E SERIES NO. Q6153990832E US SAVINGS BOND - $25.00 DENOMINATION ISSUE DATE 5/1977 E SERIES NO. 06180835637E US SAVINGS BOND - $25.00 DENOMINATION ISSUE DATE 7/1977 E SERIES NO. Q6188161668E US SAVINGS BOND - $25.00 DENOMINATION ISSUE DATE 10/1977 E SERIES NO. Q6228542799E US SAVINGS BOND - $25.00 DENOMINATION ISSUE DATE 12/1977 E SERIES NO. Q6228758685E US SAVINGS BOND - $25.00 ISSUE DATE 2/1978 E SERIES NO. Q6250567985E Value 395.94 134.46 132.12 132.12 131.05 131.03 131.03 130.08 130.08 131.36 129.04 126.51 116.34 116.34 Subtotal $ 2,067.50 Continuation of Inventory HELEN V. SHELLEHAMER 21 05 00894 Page 2 Description of Inventory Description US SAVINGS BOND - $25.00 DENOMINATION ISSUE DATE 5/1978 E SERIES NO. Q6273552115E US SAVINGS BOND - $25.00 DENOMINATION ISSUE DATE -7/1978 E SERIES NO. Q6283087711 E US SAVINGS BOND - $25.00 DENOMINATION ISSUE DATE - 9/1978 E SERIES NO. Q6293253696E US SAVINGS BOND - $25.00 DENOMINATION ISSUE DATE 12/1978 E SERIES NO. Q6303704764E US SAVINGS BOND - $25.00 DENOMINATION ISSUE DATE 1/1979 E SERIES NO. Q6289720922E SOVEREIGN BANK CERTIFICATE OF DEPOSIT NO 2895519045 Value 94.72 94.98 94.98 94.26 94.27 35,868.27 SOVEREIGN BANK CERTIFICATE OFDEPOSIT NO. 2895519052 32,178.96 SOVEREIGN BANK CERTIFICATE OF DEPOSIT NO. 3385170760 50,238.23 ORRSTOWN BANK SAVINGS ACCOUNT NO. 706001302 4,917.79 ORRSTOWN BANK CERTIFICATE OF DEPOSIT NO. 5060061630 11,630.35 ORRSTOWN BANK CERTIFICATE OF DEPOSIT NO. 5060062912 83,154.25 ORRSTOWN BANK CERTIFICATE OF DEPOSIT NO. 5060066109 7,400.00 2002 BUICK CENTURY CUSTOM SEDAN AUTOMOBILE KELLY BLUE BOOK RETAIL VALUE 10,000.00 M & T BANK SAVINGS ACCOUNT NO. 015004210919592 27,390.83 Subtotal $ 263,251.89 Continuation of Inventory HELEN V. SHELLEHAMER 21 05 00894 Page 3 Description of Inventory Description MEMBERS 1ST FEDERAL CREDIT UNION REGULAR SAVINGS ACCOUNT NO. 5832-00 Value 2,825.47 AAA MID-ATLANTIC INSURANCE GROUP INSURANCE POLICY CANCELLATION CHECK NO. 0172762 AAA CENTRAL PENN REFUND OF MEMBERSHIP DUES 67.00 9.99 UNITED CHURCH OF CHRIST HOMES REFUND OF ASSISTED LIVING COSTS 2,854.00 FOGLESANGER BRICKER FUNERAL PRE-PAID FUNERAL EXPENSE ACCOUNT 8,982.90 HOUSEHOLD PERSONAL EFFECTS SOLD AT AUCTION - ROWES AUCTIONEERING 2,422.50 CITIZENS BANK CERTIFICATE OF DEPOSIT NO. 6245-539612 10,421.21 CITIZENS BANK CERTIFICATE OF DEPOSIT NO. 6245539604 3,934.43 CITIZENS BANK CERTIFICATE OF DEPOSIT NO. 6245-539620 14,024.99 CITIZENS BANK CHECKING ACCOUNT NO. 6205363678 25,043.73 CITIZENS BANK CHECKING ACCOUNT NO. 6100731804 30,174.64 ANTHEM BLUE CROSS AND BLUE SHIELD REFUND FOR MEDICAL EXPENSES CHECK NO. 0060070748 ANTHEM BLUE CROSS AND BLUE SHIELD REFUND FOR MEDICAL EXPENSES CHECK NO. 0060070749 US SAVINGS BOND - $10,000.00 DENOMINATION ISSUE DATE 2/2005 I SERIES NO. X0020400321 93.60 249.20 10,224.00 Subtotal $ 111,327.66 Continuation of Inventory HELEN V. SHELLEHAMER 21 05 00894 Page 4 Description of Inventory Description US SAVINGS BOND - $10,000.00 DENOMINATION ISSUE DATE - 2/2005 I SERIES NO. X002040031I US SAVINGS BOND - $1 0,000.00 DENOMINATION ISSUE DATE - 2/2005 I SERIES NO. X0020400301 SECURITY FIRST ANNUITY - SINGLE PREMIUM DEFERRED ANNUITY Value 10,224.00 10,224.00 30,000.00 MEMBERS 1ST FEDERAL CREDIT UNION CERTIFICATE OF DEPOSIT NO. 5832.43 24,718.11 MEMBERS 1ST FEDERAL CREDIT UNION CERTIFICATE OF DEPOSIT NO. 5832-45 84,571.33 MEMBERS 1 ST FEDERAL CREDIT UNION CERTIFICATE OF DEPOSIT NO. 5832-46 10,852.05 MEMBERS 1ST FEDERAL CREDIT UNION CERTIFICATE OF DEPOSIT NO. 5832-47 43,093.31 Subtotal $ 213,682.80 772,209.57 Grand Total $ 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 MATEYA MARK A PO BOX 1 27 BOILING SPRINGS, PA 17007 -------- fold ESTATE INFORMATION: SSN: 199-07-1679 FILE NUMBER: 2105-0894 DECEDENT NAME: SHELLEHAMER HELEN V DATE OF PAYMENT: 04/06/2006 POSTMARK DATE: 04/16/2006 COUNTY: CUMBERLAND DATE OF DEATH: 09/13/2005 NO. CD 006528 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $9/014.06 I I I I I I I I TOTAL AMOUNT PAID: $9/014.06 REMARKS: CHECK# 116 SEAL INITIALS: RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS