HomeMy WebLinkAbout08-07-06
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15056051058
REV-1500 EX (06-05)
PA Department of Revenue '*
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT
21 06
0038
Date of Birth
206-36-2401
01/06/2006
10/24/1950
Decedent's Last Name
Suffix
Decedent's First Name
Shelley
Lisbeth
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
c..' 1. Original Return
2. Supplemental Return
CJ
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
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4. Limited Estate
C:J 4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust
(Attach Copy ofTrust)
10. Spousal Poverty Credit(date of death .. . 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
.....
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
o
8. Total Number of Safe Deposit Boxes
Michael A. Scherer, Esq
Firm Name (If Applicable)
O'Brien, Baric & Schere
(717) 249-687~
REGISTER OF WILLS USE ONLY
First line of address
19 West South Street
Second line of address
',:;
:71
City or Post Office
DATE FILED
r.....)
State
ZIP Code
Carlisle
PA
17013
Correspondent's e-mail address:
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, l!Od to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is ba . a Ion of which preparer has any knowledge.
(p
DATE I
O. .()t)
ADDRESS
19 West South Street, Carlisle, Pennsylvania 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
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15056051058
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15056051058
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15056052059
REV-1500 EX
Decedent's Name:
Lisbeth
E Shelley
206-36-2401
Decedent's Social Security Number
RECAPITULATION
1. Real estate (Schedule A). ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1.
2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3.
4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5.
6. Jointly Owned Property (Schedule F) c::> Separate Billing Requested . . . . . .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) c:::> Separate Billing Requested. . . . . . .. 7.
8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8.
9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . . . . . . . . . . . 10.
11. Total Deductions (total Lines 9 & 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 11.
12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) . .. . . . . . . . . . . . . . . . . . . . . . 14.
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .0_
16. Amount of Line 14 taxable
at lineal rate X.O 45 5,210.89
17. Amount of Line 14 taxable
at sibling rate X.12 293,301.77
18. Amount of Line 14 taxable
at collateral rate X.15 293,301.77
15.
16.
17.
18.
19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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15056052059
Side 2
158,350.00
694,352.86
5,210.89
857,913.75
17,128.92
248,970.40
266,099.32
591,814.43
591,814.43
234.49
35,196.21
43,995.27
79,425.98
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15056052059
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REV-1500 EX Page 3
File Numb!lr
Decedent's Complete Address: ! 21 J 06 j0038
DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER
Lisbeth E Shelley 206-36-2401
STREET ADDRESS
32 Liberty Court
CITY I STATE I ZIP
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
79,425.98
90,781.63
3,971.29
Total Credits (A + B + C ) (2)
94,752.92
3. InterestJPenalty if applicable
D. Interest
E. Penalty
TotallnterestJPenalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
0.00
15,326.94
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5)
(5A)
(58)
A. Enter the interest on the tax due.
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;.......................................................................................... D [K]
b. retain th~ right to designate who shall use the property transferred or its income; ............................................ D [K]
c. retain a reversionary interest; or.......................................................................................................................... D [i]
d. receive the promise for life of either payments, benefits or care? ...................................................................... D [i]
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. D [K]
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D [K]
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ [K] D
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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 three (3) percent [72 P.S. 99116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero {OJ percent
[72 P.S. g9116 (a) (1.1) (ii)]. The statute does not exempt 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 zero (OJ percent [72 P.S. g9116{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 four and one-half (4.5) percent, except as noted in
72 P.S. g9116{1.2) [72 P.S. g9116(a){1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. 99116{a){1.3)]. A sibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
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REV-1502 EX+ (6-9.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
Lisbeth Ellen Shelley
FILE NUMBER
21-06-0038
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 survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
32 Liberty Court, Carlisle, Pennsylvania - Descendent's Condominium
VALUE AT DATE
OF DEATH
158,350.00
assessed value $158,350.00
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
158,350.00
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REV-1508 EX+ (6-98) '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Lisbeth Ellen Shelley
FILE NUMBER
21-06-0038
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jolntly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1. Orrstown Bank
checking account # 106003632
33,123.70
savings account # 706002161
600,513.71
2. Nason Hospital COBRA refund
663.00
3. Citizens Bank
checking account # 6102550807
Individual Retirement Account # 6141805213
2,559.19
2,165.14
4. Omega Bank
checking account # 10847820
5. Wachovia
account # 7138-5590
6. Citi Group Smith Barney
account # 73H-02271-11
7. 2005 Chrysler Pacifica
Kelly Blue Book value $22,675.00
8. Personal Property
8,727.87
13,955.38
2,469.87
22,675.00
7,500.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
694,352.86
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REV-1509 EX+ (6-98*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Lisbeth Ellen Shelley 21-06-0038
If an asset was made )olnt within one year of the decedent's date of death, it must be reported on Schedule G.
SCHEDULE F
JOINTLY-OWNED PROPERTY
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A.
B.
C.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY.HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENrs INTEREST
1. A. Orrstown Bank, Account # 400882 10,421.77 1/2 5,210.89
TOTAL (Also enter on line 6, Recapitulation) $ 5,210.89
(If more space is needed, insert additional sheets of the same size)
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REV.1511 EX+ (12-99)*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
leMIDUU H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Lisbeth Ellen Shelley
FILE NUMBER
21-06-0038
Debts of deeedent must be reported on Schedule 1.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Hoffman Roth Funeral Home
6,043.03
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
Slate
Zip
Year(s) Commission Paid:
2.
Attomey Fees 0 I Br i en, Bar i c & Scherer
7,500.00
3. Family EXllll1plion: (If decedent's address is not the same as claimant's. allach explanation)
Claimant
Street Address
City
Slate
.Zip
Relationship of Claimant to Decedent
4. Probate Fees
5.
Accountant's Fees S m i thE 11 i 0 t & K ear n s
2,000.00
6. Tax Retum Preparer's Fees
11.
Com east Cable
Judy Campbell- county/township taxes
Andrew S. Kronenberg- stamps
32.61
238.50
531.90
254.66
393.69
40.79
8.
Erie Kronenberg-Cumberland County landfill
Midway Self Storage
UGI
7.
9.
10.
12.
TOTAL (Also enter on line 9, Recapitulation) $
(II more space is needed, insert additional sheets 01 the same size)
17,035.18
Estate of Lisbeth Ellen Shelley
File # 21-06-0038
CONTINUATION OF SCHEDULE H
13. Met Ed -electric
14. Verizon
15. Sprint
Total:
$25.55
$21.51
$46.68
$93.74
TOTAL: $17,128.92
REV.l512 EX+ (12-03)
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SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE UABIUTlES, & LIENS
COMMOMN~THOFPENNSYlVAN~
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21-06-0038
ESTATE OF
Lisbeth Ellen Shelley
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unrelmbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Mortgage
10.
11.
Orrstown Bank Account # 6000475
137,969.36
secured by 32 Liberty Court, Carlisle, Pennsylvania
2.
Met Ed
108.46
3.
305.69
UGI
4.
Lancaster HMA
60.00
5.
Chrysler Pacifica
546.02
6.
Fairview Storage
410.00
7.
Com cast
122.04
8.
Waste Management of Central PA
43.65
9.
Sprint
2.85
South Middleton Township Municipal Authority
99.00
U.S. Treasury-federal taxes
90,071.00
12.
PA Department of Revenue-state taxes
14,399.00
13.
Mayapple Village-association dues
500.00
14.
Unum Provident-over payment reimbursement
4,333.33
248,970.40
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
.
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LAST WILL AND TESTAMENT
OF
LISBETH E. SHELLEY
I, LISBETH E. SHELLEY, of Blair County, Pennsylvania, declare this to be my
Will and revoke all prior Wills.
FIRST:
Tangible Personal Property: I give all of my tangible personal
property, including any automobiles, together with all insurance on such property, to sister,
JOANNE S. KRONENBERG, and my nephew, ANDRE\\-' SHELLEY KRONENBERG, to be
divided among them as they shall agree. If there is no agreement, this property shall be sold and
the proceeds shall be added to the residue of my estate. My Executor shall pay, as an expense of
settling my estate, the costs of packing, storage, shipping and insurance incurred in connection
with the distribution of the gifts of tangible personal property made above.
SECOND:
Specific Devise of Residential Property: I give and devise to my
.~
parents, WILLIAM L. SHELLEY and LUCILLE C. SHELLEY, jointly, if both survive me, or
the entire interest to the survivor if only one survives me, my real estate, known as Seagulls
Condominium No. 512,200 Renn Street, Tavernier, Florida, together with any fire insurance
policies thereon, free and clear of any encumbrances thereon at the date of my death, including,
but not limited to, mortgages, liens, tax arrearages and assessments, which encumbrances I direct
to be paid as debts of my estate.
THIRD: Residue: I give, devise and bequeath all of the residue of my estate, of
whatever nature and wherever situated (including lapsed legacies and devises), as follows:
IOS410.\ SII8I04
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A. One share equal to FIFTY PERCENT (50%) of such residue to my sister,
JOANNE S. KRONENBERG, if she survives me. If she fails to survive me, this share shall be
added to the share for my nephew, ANDREW SHELLEY KRONENBERG in subparagraph B
and distributed in the manner provided therein.
B. One share equal to FIFTY PERCENT (50%) of such residue to my
nephew, ANDREW SHELLEY KRONENBERG, ifhe survives me. Ifhe fails to survive me,
this share shall be added to the share for my sister, JOANNE S. KRONENBERG in
subparagraph A and distributed in the manner provided therein.
C. If there is a complete failure of beneficiaries under both subparagraph A
and subparagraph B, such shares shall be distributed to Margaret E. Koss, Christopher Eric
Kronenberg, and William M. Kronenberg.
FOURTH: Trust Provisions for Certain Beneficiaries:
A. Any income or principal (other than tangible personal property)
distributable to <a beneficiary (other than ANDREW SHELLEY KRONENBERG) under the age
,
of twenty-five or who, in the sole determination of the Executor or Trustee, is incapacitated, shall
be held in a trust fund by the Executor during the administration of my estate and thereafter by
the Trustee. The Executor or Trustee may apply such amounts of the income and principal
otherwise distributable as the Executor or Trustee, in the sole discretion of the Executor or
Trustee, deems proper for the support, health, education and welfare of such beneficiary, either
by direct payment of bills, or by payments to such beneficiary, his or her duly appointed
guardian of the estate or person, or any person (including the parent of a beneficiary under the
age of twenty-five) who has the care or control of such beneficiary, as the Executor or Trustee
selects.
I0S410.1 SIIIlI04
-2-
B. The Executor or Trustee shall distribute the balance of principal of any
fund held in trust hereunder to such beneficiary when the beneficiary attains age twenty-five or,
in the sole determination of the Executor or Trustee, is no longer incapacitated, whichever is
later. If such beneficiary dies before attaining age twenty-five or while incapacitated,
distribution shall be made to the estate of the beneficiary.
C. Whenever, in the sole determination of the Executor or Trustee, any fund
held in trust under this Article FOURTH is or has become too small to warrant establishing or
continuing such fund in trust, or its administration is or becomes impractical for any other
reason, the Executor or Trustee, in the Executor or Trustee's sole discretion, may pay such fund,
outright, to the guardian of the estate or person of the beneficiary of such fund, or to any person
(including the parent of a beneficiary under the age of twenty-five) who has the care or control of
such beneficiary. In the case of a beneficiary under the age of twenty-five, the Executor or
Trustee may pay such fund, outright, to a custodian for such beneficiary under the age of twenty-
five under a U~form Transfers to Minors Act or Uniform Gifts to Minors Act or may deposit
such fund in an interest-bearing account in a financial institution of the Executor or Trustee's
choosing, payable to the beneficiary upon attaining age twenty-five.
D. The Executor or Trustee shall not be obliged to supervise or inquire into
the application of any distributions of income or principal made under this article and the receipt
by a payee designated hereunder shall be a complete release of the Executor or Trustee.
FIFfH: Protective Provision: All principal and income shall, until actual
distribution to the beneficiary, be free of the debts, contracts, alienations and anticipations of any
beneficiary, and shall not be liable to any levy, attachment, execution or sequestration while in
the hands of my Executor or Trustee.
10S410.15I18/04
-3-
SIXTH:
Tax Clause: All estate, inheritance, succession and other death
taxes, imposed or payable by reason of my death, and any penalties thereon, with respect to all
property owned by me at the time of my death and passing under this Will or any Codicil (the
"Taxes"), shall be paid out of the principal of my residuary estate, as if the Taxes were
administration expenses, without apportionment or right of reimbursement. The Taxes shall be
paid at such time or times as my Executor may deem advisable.
SEVENTH: Powers of Executor and Trustee: In addition to the powers given
by law, my Executor and Trustee, and any successors, without any order of court and in the sole
discretion of the Executor and Trustee, may:
a. Retain any real or personal property, as long as deemed advisable.
b. Invest in any real or personal property in accordance with the
prudent investor rule.
c. Subscribe for stocks, bonds or other investments; join in any plan
of lease, mortgage, merger, consolidation, exchange, reorganization, foreclosure or
voting trust and deposit securities thereunder; and generally exercise all the rights of
security holders or employees of any corporation.
d. Register securities in the name of a nominee or in such manner that
title will pass by delivery.
e. Vote securities in person or by proxy, and in such connection
delegate discretionary powers.
f. Repair, alter, improve or lease, for any period of time, any real or
personal property, and give options for leases.
g. Sell at public or private sale, for cash or credit, with or without
security, exchange or partition any real or personal property, and give options for sales or
exchanges.
h. Borrow money from any person, including any fiduciary, and
mortgage or pledge any real or personal property.
i. Disclaim any interest or power granted to me under any instrument
or by operation oflaw.
105410.1 SII8I04
-4-
j. Employ investment and legal counsel, accountants, brokers and
other specialists, and, whenever there shall be no corporate fiduciary in office, a
corporate custodian, and compensate them and reimburse their expenses out of income or
principal or both (in addition to fiduciary commissions), and delegate to investment
counsel (including an account executive at a securities firm) discretion with respect to the
investment and reinvestment of any or all of the assets held hereunder.
k. Pay administration expenses, including, without limitation, interest
on death taxes ("administration expenses") from principal or income, including income
otherwise payable to charity; provided, however, that no allocation of administration
expenses to income shall be made that would prevent any assets from otherwise
qualifying for the federal estate tax charitable deduction.
1. Use administration expenses as deductions for federal estate tax
purposes or fiduciary income tax purposes or partly for each, without making adjustments
between principal and income in consequence of the exercise of such discretionary
power.
m. Compromise claims.
n. Divide any trust hereunder, which division may be made on a non-
pro rata basis, into two or more separate and independent trusts and make any principal
distributions otherwise authorized hereunder from the trusts on a non-pro rata basis.
o. Add to the principal of any trust created hereby any property
received from any person by Deed, Will or in any other manner.
. p. At any time merge any trust hereunder with any other trust held by
my Exe6utor and Trustee~ whether created by me or by any other person by Will or Deed,
if the terms of the trust are then substantially similar and held for the primary benefit of
the same person or persons.
q. Make distributions without the consent of any beneficiary, in cash
or in specific property, real or personal, or an undivided interest therein, or partly in cash
and partly in such property and do so, except as otherwise specifically provided
elsewhere herein, without regard to the income tax basis of specific property allocated to
any beneficiary (including any trust) and without making pro rata distribution of specific
assets.
r. Allocate basis pursuant to Section 1022 ofthe Internal Revenue
Code of 1986, as amended, or successor provisions (the "Code"); provided, however, that
such allocation shall be made in a fair and equitable manner among the beneficiaries of
my estate, as my Executor, in my Executor's sole discretion, shall determine.
s. Exercise all power, authority and discretion given hereby, after the
termination of any trust created herein until the same is fully distributed.
105410 I 5/18/04
-5-
,
My Executor and Trustee may make, but shall not be required to make, any
adjustment of the amount distributed to any beneficiary who would have received a greater or
lesser amount if my Executor or Trustee had made a different or contrary decision in reference to
any otthe above matters. I exonerate my Executor and Trustee from any liability arising from
any exercise or failure to exercise these powers, provided the actions (or inactions) of my
Executor or Trustee are taken in good faith.
EIGHTH:
Appointment of Fiduciaries: I appoint my sister, JOANNE S.
KRONENBERG, and my nephew, ANDREW SHELLEY KRONENBERG, and the survivor of
them, Executor of and Trustee under this Will.
No Trustee who is a beneficiary or who owes a legal duty of support to a
beneficiary shall participate in any discretionary decision relating to the right of such beneficiary
in or to principal or income or in any determination of such beneficiary's incapacity. In such
cases the decision of the other Trustee shall control.
~o Executor or Trustee appointed herein shall be required to give bond or furnish
>
sureties in any jurisdiction. Whenever the word "Executor" or the word "Trustee" is used in this
Will, the word shall include both the singular and the plural, unless the context indicates
otherwise.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this J-r day of
M~V ' 2004.
'/Y:iJ,,1tv ~,/;5hea~~
LISBETH E. SHELLEY
(SEAL)
105410.15118104
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SIGNED. SEALED. PUBLISHED and DECLARED by the above named
LISBETH E. SHELLEY as and for her last Will and Testament. in the presence of us. who. at
her request. in her presence and in the presence of each other. have hereunto subscribed our
nameS as witnesses.
~cf.~.
WITNESS ~
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WI SS
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ADDRESS I
105410.15/18104
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COMMONWEALTH OF PENNSYLVANIA
COUNTY OF \) tLv..{J";"
ss
We, LISBETH E. SHELLEY, the testator. and ~N\S6 L. ~A~':<'Nc"E:tl-
and ~ K8\htJ t'-^.. SCO\f"
, the witnesses, whose names are signed to the
foregoing instrument. being first duly sworn, do hereby declare to the undersigned authority that
the testator signed and executed the instrument as her last Will and that she signed willingly, and
that she executed it as her free and voluntary act for the purposes therein expressed, and that each
of the witnesses, in the presence and hearing of the testator, signed the Will as a witness and that
to the best of the witnesses' knowledge the testator was at that time over eighteen years of age, of
sound mind and under no constraint or undue influence.
~"Ihlf/Wi, 7tJ{a~
LISBETH E. SHELLEY
~J~
~'l~~
Witness
Subscribed. sworn to and acknowledged before me by LISBETH E. SHELLEY.
the testator. and subscribed and sworn to before me by "1)G N \SE L. ~ Po. H t2.1 Nu eQ..
and K~v IN tv\.. <3COTT"
· the Wj7J ;-;u.y of ttl'1 ,2004.
~ftI
Notary Public
Notarial Seal
Lori A. B. Zerbe. Notary Public
CIty Of HarrisbUtg. Dauphin County
My Corr\mISSiOIl Expires Jan. 7. 2006
Member. Pent':syl\'Mia I\ssocia.tion cv. N<:J.2fies
, \
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1054\0.\ S/IBl04
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Page 1 of 1
Detailed Results for Parcel 40-24-0760-122. in the 2004 Tax Assessment Database
DistrictNo 40
Parcel_ID 40-24-0760-122.
MapSuffix
HouseNo 32
Direction
Street LIBERTY COURT
Ownerl SHELLEY, LISBETH E
C/O
PropType R
PropDesc
Liv Area 1688
CurLandVal 30950
CurImpVal 127400
CurTotVal 158350
CurPreCVal
Acreage 0.17
CIGrnStat
TaxEx 1
SaleAmt 185000
SaleMo 5
SaleDa ", 27
SaleCe 20
SaleYr 05
DeedBkPage 00269-00439
YearBIt 1994
HF _File_Date 12/2/2004
HF _Approval_Status R
http://taxdb.ccpa.net/ details.asp ?id=40-24-0760-122.&dbselect= 1
3/9/20~
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K~:;.8EG,Tft. Z:2GLER
tiECCRDEE 0;: DEft'S
GU.'.~EERLt,~~r.: C'~,':'l~.';'.-P_.\
Parcel No.: 40-24-0760-122
2006 APR 10 Prl 3 00
THIS DEED
MADE THE (J:!l day of April in the year of our Lord Two Thousand Six (2006).
BETWEEN JO ANNE S. KRONENBERG and ANDREW S. KRONENBERG, Executors
of the Estate of Lisbeth Ellen Shelley, late of Cumberland County, Pennsylvania,
hereinafter Grantors
AND ANDREW S. KRONENBERG, single man, of Cumberland County, Pennsylvania,
hereinafter Grantee
WITNESSETH, the said Lisbeth Ellen Shelley, by her Last Will and Testament, duly
proved and recorded in the Register's office of Cumberland County, Pennsylvania, as
Estate No. 21-06-0038, provided inter alia, as follows:
EIGHTH: I appoint my sister, Joanne S. Kronenberg and my nephew, Andrew Shelley
Kronenberg, and the survivor of them, Executor of and Trustee under this will...
NOW THIS INDENTURE WITNESSETH, that the said Grantors, by virtue of the power
and authority aforesaid, in said Will contained, and in consideration of the sum of One
and 00/100 ($1.00) Dollar to it paid by the said Grantee, at and before the unsealing and
delivery of these presents, the receipt whereof is hereby acknowledged, have granted,
bargained, sold and conveyed and does hereby grant, bargain, sell and convey to the
said Grantee, his heirs and assigns forever.
ALL THAT CERTAIN lot or parcel of land situate in South Middleton Township,
Cumberland County, Pennsylvania, more particularly bounded and described as
follows:
BEGINNING at a point on the northeastern line of Liberty Court (private road) at the
corner between Lots Nos. 8 and 17 on the hereinafter described Final Subdivision Plan
for the Mayapple Village, Prestwick Townhouse Lots ("Plan"); thence along the
boundary line between Lots Nos. 8 and 17, North 45 degrees 04 minutes 22 seconds
e~. 273 PACE4?48
........
.- .
~ '"
West, a distance of 140.00 feet to a point on the boundary lines between Lots Nos. 8 and
17 of other lands of Mayapple Village; thence along the other lands of Mayapple
Village, North 44 degrees 55 minutes 38 seconds East, a distance of 36.48 feet to a
concrete monument; thence from said concrete monument, North 60 degrees 13 minutes
46 seconds East, a distance of 40.60 feet to the dividing line between Lots Nos. 8 and 9
along other lands of Mayapple Village; thence from said point along the dividing line
between Lots Nos. 8 and 9, South 25 degrees 25 minutes 56 seconds East, a distance of
140.44 feet to a point along the dividing line between Lots Nos. 8 and 9 on the
northeastern line of Uberty Court (private road); thence along a curve to the left, having
a radius of 137.00 feet, an arc distance of 28.64 feet along a chord bearing of South 50
degrees 54 minutes 59 seconds West, a chord length of 28.59 feet to the point and place
of BEGINNING.
BEING Lot No.8 on the Final Subdivision Plan for the Mayapple Village Prestwick
Townhouse Lots, dated February 25, 1994 and recorded in the Office of Recorder of
Deeds of Cumberland County, Pennsylvania, in Plan Book 67, Page 145.
HAVING thereon erected a dwelling house known as 32 Liberty Court, Carlisle,
Pennsylvania.
BEING the same premises which John W. Towne and Amy J. Towne, by Deed dated
May 27, 2005 and being recorded in the Office of the Recorder of Deeds in and for .
Cumberland County, Pennsylvania, in Deed Book 269, Vol. , Page 439, granted and
conveyed unto Lisbeth E. Shelley. The said Lisbeth E. Shelley died January 6, 2006,
whereby title became vested by law in her estate.
UNDER AND SUBJECT, NEVERTHELESS, to any existing covenants, easements,
encroachments, conditions, restrictions and agreements affecting the property.
TOGETHER with all and singular, the tenements, hereditaments and appurtences to the
same belonging, or in anywise appertaining, and the reversion and reverrsions,
remainder and remainders, rents, issues and profits thereof; and also, all the estate,
right, title, interest, property claim and demand whatsoever, both in law and equity, of
the said Grantors, of, in to or out of the said premises, and every part and parcel
thereof.
TO HAVE AND TO HOLD the said premises, with all and singular the appurtences,
unto the said Grantee, his heirs and assigns, to and for the only proper use and behoof
of the said Grantee, his heirs, assigns and successors forever.
COOK 273 ~AGE4749
--'--'1----
, .......... ..-
t#
IN WITNESS WHEREOF, the said Grantors have hereunto set their hands and seals
the day and year first above written
5.IGNED, SEALED AND DEUVERED IN
THE PRESENCE OF:
'-
~~
19~
pr,f
~~~ (SEAL)
NBERG
STATE OF PENNSYLVANIA
: 55.
COUNfY OF CUMBERLAND
On this, the ~tn day of A pn I , 2006, before me, the
undersigned officer, personally appeared Jo Anne S. Kronenberg and Andrew S.
Kronenberg known to me (or satisfactorily proven) to be the persons whose names are
subscribed to the within instrument, and acknowledged that they executed same in the
capacity.~therein stated and for the purposes therein contained.
IN WITNESS HEREOF, I hereunto set my hand and official seal.
~~~
MM NWEAL; OF Pftr~lC;YLVANIA
Notarial S, ;
~L. Fisher "'~"1' Public
CarIis1cBoro, Cun-" .. .' ..!lid County
M Commission Ex " .;\ r. 17. 2006
Member, Pennsytvanle J.' . .;~iation of Notaries
800~ 273 f~GE4 '750
.....~,_. ,v. ~..._
'0'
4- ;..
CERTIFICATE OF RESIDENCE
I do hereby certify that the precis~ residence and complete post office
(lddress of the within named grantee is 3~ Ub~ Cow-t, CarlIsle; PA- 17013.
~2006.
/f1ULh-
Attorney for Grantee
I Certl'fy tIll' <:' fA he rccnr,i,,:'
1...' '......f ..,/\.1 ~ _' .." ...".. ..
In Cumbp.rl:~,"'d rC):'.n~'/ p/,
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O' BRIEN, BARIC & SCHERER
19 WEST SOUTH STREET
CARLISLE, PENNSYLVANIA 17013
BOOK 273 tACE4751
.,"
.--........-" ...
. .
,
.' v
REV-183 EX (11-04)
*'
REALTY TRANSFER TAX
STATEMENT OF VALUE
RECORDER'I USE ONLY
S1Ib Ta PIIld _
Book Number
CQMMONWEALllt OF PENNSYlVANIA
DEPARTMENT OF REVENUE
BUREAU cw ItHlMDUAL TAXES
PO BOX :zeoeos
HMRIS8URG PA 1712&-0603
Complete each section and file In duplicate with Reoonler of Deeds ,when (1) Ihe fun vaIueIc:onaIder8tlon 18 not set forth In tile deed, (2) when the
deed is without consideration, or by gift, or (3) a tax exemption Is cIallned. A Statement of VaJue Is not reqlRd If Ihe transfer Is whoIy txerl1lC from
tax based on: (1) family relationship or (2) PUbrlC utility easement. If more space is needed, atIad18dditlon81 sheet(s).
A. CORRESPONDENT - Alllnaulrles may be directed to the followlna person:
Name Telephone Number:
UlrC (111 ~4q-Ia~?3
State Zjp Code
PA 17013
See Reverse for Instructions
,.. Number
0. RiM:orded
t-<roncnbcr
Court
ZIp Code
17013
2. 01her ConsIdereUon
+ 0.00
5. Common Leyel Ratio Factor
X 1.00
3. T018l ConsIderation
= 1.00
6. Fair Market Value 0
= 15~ 350.0
1a. Amount of exemption Claimed
100"/0
1b. Percentage of Interest Conveyed
{OOGe>
2. Check Appropriate Box Below for exemption Claimed
~ Will or intestate succession Lisbcl-Vl Ell en Shel kin
(Name of Deced t)
o Transfer to Industrial Development Agency.
o Transfer to a trust. (Attach complete copy of trust agreement identifying all beneficiaries.)
o Transfer between principal and agent. (Attach complete copy of agency/straw party agreement.)
o Transfers to the Commonwealth, the United States and Instrumentalities by gift, dedication, condemnation or in lieu
of condemnation. (If condemnation or in lieu of condemnation, attach copy of resolution.)
o Transfer from mortgagor to a holder of a mortgage in default. Mortgage Book Number . Page Number _'
o Corrective or confirmatory deed. (Attach complete copy of the prior deed being corrected or confirmed.)
o Statutory corporate consolidation, merger or division. (Attach copy of~rticl8s.) I.....J. 1_ L "r par-! oF'ihe
kti . ~-He to r-ca. G.:>lOa;.. WOS TO pass u.;o
~ Other (PleaSE! explain exemp~ol1 claimed. if o.ther lI1a.J1li~ted above.) re5lduo.rv esh:l.h to ,Jo Anne s. krone"be~
a.rd Andrew S. Kronenberll: A f-CtntLf,o.l ~pho(J c:lClSts betweeJ\ Jo Itnne S.~ronalb~rq Ithd I\-ndtC/iII S Kronenber;
os they a.rc. N'lotl1er o..M SDY! . Pwsua.nf to Ba~l-Ir BrctVtcr.s;tt-c tTo-"sR.,.- nqm t-he:: '-:She. I ley csra l-e. to ~
Ardr-ew S. krorc"~ is tnxe;c.empl-.
Under penalties of law, t declare that I have examined this Statement, Including accompanying information, and to the best
of my knowledge and belief, It is true, correct and complete.
Slg"1,nt :~f CDml~t 1r ~e~~eta: I Oat.
~~ .. ~-IO-{Jb
FAILURE TO COMPLETE THIS FORM PROPERLY OR ATTACH APPLICABLE DOCUMENTATION MAY RESULT IN
THE RECORDER'S REFUSAL TO RECORD THE DEED.
J I-Olc.- 003$
(Estate File Number)
800K 273 PACE4752
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Pamela J. Kuenzie
Branch Executive Officer
Phone 717~240-0686
Fax 717-240-0804
January 25, 2006
Michael A Scherer
O'Brien, Baric & Scherer
19 West South Street
Carlisle, PA 17013
RE: Lisbeth E. Shelley
S.S. # 206-36-2401
Dear Mr. Scherer:
In response to your request for written veritication of account information for
Lisbeth E. Shelley, I offer the following: .
. All accounts, including the mortgage, were titled: Lisbeth E Shelley.
605 Devonshire Drive
Carlisle, PA 17013
Balances as of January 6, 2006: .
, .
Checking account # 10'6003632 == $ 33,123.70
Savings account # 706002161 $600,513.71
Mortgage # 6000475
= $137,969.36
If there is anything more I can do to help, please do not hesitate to call.
. : , . I - '. _' '. .. ,~-
Very truly yours," ....;.
gWNBANK . .
Pamela J. Kuenzie .
Branch Executive Officer
I~~~.
PO Box 250 . Shippensburg, PA 17257.- (717) 532-6114 · (717) 532-4143 Fax · www.orrstow~.com
.'
~~ Citizens Bank'"
Account Number 6102550807
Account Title LISBETH ELLEN SHELLEY
Date Opened 5/17/1988
Account Type Checking
Principal Balance as ofDOD $2559.19
Interest from Last Posting to DOD $.00
Account Balance as of DOD $2559.19
YTD Interest to DOD $.00
"
.
a Citizens Bank-
Account Number 6141805213
Account Title LISBETH ELLEN SHELLEY
Date Opened 4/1111996
Account Type Time Deposits (IRA)
PrincipwBw~ce~ofDOD $2165.02
Interest from L~t Posting to DOD $ .12
Account Bw~ce ~ ofDOD $2165.14
YTD Interest to DOD $.00
",
~
(i) OMEGA BANK
Member FDIC
01/23/2006
OBRIEN BARIC & SCHERER
MICHAEL A SCHERER
19 WEST SOUTH STREET
CARLISLE PA 17013
Dear Mr. Scherer,
This letter is in regard to the accounts that Lisbeth E. Shelley held at our financial institution. Listed
below is the information that you requested.
Account Type:
Account Number:
Ownership:
Date Opened:
Balance as of 000
Accrued Interest:
Checking
10847820
Individual
10/04/2002
$8,727.87
n/a * See Note Below
If I can offer.any further assistance, please contact me at your convenience.
*Note: Accrued interest is not included in Date of Death balance.
Sincerely,
;j~AL4
Felicia Shultz
Deposit Services Representative
Telephone 1-800-494-1810 ext 2061
Fax: (814) 231-7680
fshultz@omef.com
Page 1 of2
PO Box 298 State College, PA 16804-0298 Customer Information Center, Toll Free: 1-877-861-7800
~.tI#H~alUtaltetat.~
.
03-22-2006 12:35pm From-
II
t.4".flw,~,r:;I/t:,~
+
T-693 P.002/002 F-889
wactlovla Securiti~S. Ll.C
One PPG Place
Suitll 2200
Plttsb\Jrgh. PA 15222
Tel 412 394-3100
ra~ 412 394.3166
800 777.2488
Wednesday, March 22, 2006
WAOROV'IA. SlI:CUlU'.l'fI...':i
O'Brien, Baric & Scherer
Ann: Michael A. Scherer
19 West South Street
Carlisle, PA 17013
Re: Lisbeth Ellen Shelley
Account # 7138-5590
Dear Mr. Scherer:
In response to your letter the above account was tided in her sole name, Lisbeth E.
Sh~l1ey, MD and the account was opened on October 18, 1996.
The following mutual fund was held in the above account and the value as oflhe date of
death, January 6,2006 is as fonows:
Description
Quantity
Price
Amount
Evergreen Core Bond Fund
Class C .
"
1,331.62000
10.48
$13,955.38
If you have any questions or need any additional information please feel free to call me a
412-394-3193
Sincerely,
(!~1N~
<;arole Ward
Account Administrator
Edward T. Turk
Vice President - Investments
The above summary of prices/quotes/statistics has been obtained from sources believed
to be reliable, but is not necessarily complete and cannot be guaranteed. Prices may not
reflect the value at which securities could be sold. This summary is for informational
pwposes only. Past results do not indicate futUre performance. This is not a substitute for
a Verification of Deposit or the official statement account hOldings at the finn.
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BLUE BOOK- PRIVATE PARTY VALUE 4UJHIlT'$ THin
Condition
Value
$24,120
"K"';'.:-,'t<':.'k~~
iJ Estim
. $448/rr
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... Get a Pre
from 6.4~
.. Your Cre,
" Get a Fre
-a
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2005 Chrysler Pacifica Limited Minivan
.~ Trade-In Value
l:~"'p~i;~t~p~rtYv~i~~H""
... Suggested Retail Value
" Photo Gallery
,. Review
Excellent
J. WHRT'S THIS?
Good
$22,675
(Selected)
THE 2C
PAC
http://www.kbb.com/kblki.dll/kw.kc.ucp?kbb.PA;;PA041;&17013&;61977f>&;;ucp;&2;C...1/20/2006 .
J. WHRT':> THIS?
Ii More Photos
Fair
$20,820
... V..fHAT';;' THlS?'
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Vehicle Details
o Change Equipment
i Engine: V6 3.5 Liter
Transmission: Automatic
Drivetrain: AWD
Mileage: 15,000
Selected Standard Equipment
Air Conditioning AM/FM Stereo
Power Steering Cassette
Power Windows Multi Compact Disc
Power Door Locks Parking Sensors
Tilt Wheel Dual Front Air Bags
Cruise Control
Front Side Air Bags
ABS (4-Wheel)
Moon Roof
Roof Rack
Alloy Wheels
Blue Book Private Party Value
Private Party Value Is what a buyer can expect to pay when buying a used
car from a private party. The Private Party Value assumes the vehicle is sold
"As Is" and carries no warranty (other than the continuing factory
warranty). The final sale price may vary depending on the vehicle's actual
condition and local market conditions. This value may also be used to derive
Fair Market Value for Insurance and vehicle donation purposes.
~
, '
DECEASED
E 1040 2005\ ~\
6 U.S. Individual Income Tax Return IRS Use Only - Do not write or staple in this space.
". label For the yeat Jan. I-Dec. 31, 2OOS, or other tax yeat beginning . 2OOS, ending 20 OMS No. 1S4S-Q074
Your first name and initial last name (DEC. 01/05/06) You social security number
(See L SHELLEY 206 \ 36 ~ 24'01
instructions A LISBETH E.
on page 16.) B II a joint return, spouse's first name and initial last name Spouse's social security number
E
Use the IRS L
label. H Home address (number and street). If you have a P.O. box, see page 16. I Apt no. You must enter
Otherwise, E 609 DEVONSHIRE DRIVE ... your SSN(s) above....
p lease print R City, town or post office, state, and ZIP code. II you have a loreign address, see page le.
or type. E Checking a box below will not
Presidential 'CARLISLE PA 17013 change you tax or relUnd.
Exemptions
Check here if you, or our spouse if filin jointly, want $3 to
Single
D Married filing jointly (even il only one had income)
D Married filing separately. Enter spouse's SSN above
D
Election Campaign ~
1
Filing Status 2
3
Check only
one box.
--L
last name
(2) Dependent's social
security number
(3) Dependent's
relationship to
you
II more than four
dependents
Dependents on 6c
not entered above
see page 19. : : Add numbers ~
d Total number 01 exemotions claimed .............. .............. ...... .......... ........ .................................... .. .......... :~~:s~
Income 7 Wages, salaries, tips, etc. Attach Form(s) W-2 ................. . ........................................................... 7 70,809.
Sa Taxable interest Attach Schedule B if required 8a 43.
Attach Form(s) b Tax-exempt interest. Do not include on line 8a ::.::::::::::::::::::::::::::..j..Sb..j.................................
W-2 here. Also ...
attach Forms 9a Ordinary dividends. Attach Schedule B if required ........................................................................ 9a 476.
W-2G and b Qualified dividends (see page 23) ................................................ I 9b I
1099-R il tax
was withheld. 10 Taxable refunds, credits, or offsets 01 state and local income taxes ........... .......... ..... ........ ....... .... .... .... 10
11 Alimony received ..................................................................................................................... 11
12 Business income or (loss). Attach Schedule C or C-EZ .....................................................-............... 12
If you did not 13 Capital gain or (loss). Attach Schedule D if required. If not required, check here .....................~ D 13 452.679.
get a W-2,
see page 22. 14 Other gains or (losses). Attach Form 4797 .................................................................................... 14
15a IRA distributions ..................... t:j I b Taxable amount (see page 25) 15b
Enclose, but do 16a Pensions and annuities b Taxable amount (see page 25) 16b
not attach, any ............ 16a
payment. Also, 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E .................-...... 17
please use 18 Farm income or (loss). Attach Schedule F ....-............................................................................... 18
Form 1040-V. 19 Unemployment compensation 19
...................................................................................................
20a Social security benefits ............ I 20a I 24,443.1 b Taxable amount (see page 27) 20b 20.777.
21 Other income. List Iype and amount (see page 29)
21
22 Add the amounts in the far riaht column for lines 7 throuah 21. This is vour total income .... ......... .. ~ 22 544 784.
23 Educator expenses (see page 29) 23
Adjusted 24 Certain business expenses 01 reservists, 'pii-iOmliriij iirtisi.; 'and ie:.;:basls 'govemmeni 24
officials. Attach Form 210e or 210&-EZ ...................................................
Gross 25 Health savings account deduction. Attach Form 8889 ........................ 25
Income 26 Moving expenses. Attach Form 3903 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
27 One-half of self-employment tax. Attach Schedule SE ................. . ..... 27
28 Self-employed SEP, SIMPLE, and qualified plans .............................. 28
29 Self-employed health insurance deduction (see page 30) ..................... 29
30 Penally on early withdrawal of savings ...... ...................................... 30
31a Alimony paid b Recipient's SSN ~ : : 31a
32 IRA deduction (see page 31) ......................................................... 32
33 Student loan interest deduction (see page 33) ................................. 33
34 Tuition and fees deduction (see page 34) .......................................... 34
35 Domestic production activities deduction. Attach Form 8903 ............... 35
36 Add lines 23 through 31a and 32 through 35 ................................................................................. 36
S1oo01 37 Subtract line 36 from line 22. This is vour adiusted aross income ~ 37 544 784.
1'-05-0S .............................................
lHA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 78.
Form 1040 (2005)
.
Tax and 38 Amount from line 37 (adjusted gross income) .... ................................................................-................. 38 544,784.
Credits 39a Check { D You were born before January 2, 1941, D Blind.} Total boxes. r
Standwd if: D Spouse was born before January 2,1941, D Blind. checked..... 391
Deduction fo< .
. People who b If your spouse itemizes on a separate return 0< you were a dual-status alien, see page 35 and check here ...... .. 39b D
checked any 40 Itemized deductions (from Schedule A) or your standard deduction (see left margin) ;IE 40 2 983.
box on line 39a ... ................ ....
0< 39b or who 41 Sublraclline 40 from line 38 41 541 801.
can be claimed ....... ........................................... ....................... .....................
as a dependent 42 If line 38 is over $109,475, or you provided housing to a person displaced by Hurricane Katrina,
see page 37. Otherwise, multiply $3,200 by the total number of exemptions claimed on line 6d ................. ...... 42 O.
43 Taxable income. Sublractline 42 from line 41. If line 42 is more than line 41, enter -0- .... . . . . . . . . . . . . . . . . . . . . . . . . . - . 43 541,801.
. All others: 44 Tax. Check if any tax is from: aD Form(s) 8814 bD Form 4972 ............ 44 87.364.
... .....................................
Single 0< 45 Alternative minimum tax. Attach Form 6251 45 2.242.
Married filing ......................................... ..... o . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
separately, 46 Add lines 44 and 45 ~ 46 89.606.
$5,000 .........-. . . . . . . . . . . . . . . . . . . . .......................................... ..... ......... ......................
Married filing 47 Foreign tax credit. Attach Form 1116 if required. ...00.......... H....... ...00...... 47
jointly 0< 48 Credit for child and dependent care expenses. Attach Form 2441 .. H....... ...... 48
Qualifying 49 Credit for the elderly or the disabled. Attach Schedule R ..... H................... 49
w'dow(er1 ...
$10,000 50 Education credits. Attach Form 8863 50
... ..............................................
Head of 51 Retirement savings contributions credit. Attach Form 8880 51
household, ........................
$7,300 52 Child tax credit (see page 41). Attach Form 8901 if required 52
. . . . . . . . . . . . . . . . . . .....
53 Adoption credit. Attach Form 8839 ......... ...... .... 53
54 Credits from: a D Form 8396 b ..C1'F~~~8859...... .... 54
D Form 3800 ..... .........
55 Other credits. Check applicable box(es): a
b D Form 8801 c D Form ...... 55
56 Add lines 47 through 55. These are your total credits .00...00...0000..00..............00.......00..00............................. 56
57 Subtract line 56 from line 46. If line 56 is more than line 46 enter -0- ..... H. ........ ................ 0000........... ~ 57 89.606.
Other 58 Self-employment tax. Attach Schedule SE . ........................................................................................... 58
Taxes 59 Social security and Medicare tax on tip income not reported to employer. Attach Form 4137 ........................... 59
60 Additional tax on IRAs, other Qualified retirement plans, etc. Attach Form 5329 if required .............................. 60
61 Advance earned income credit payments from Form(s) W-2 ............00........00........00.............................00.... 61
62 Household employment taxes. Attach Schedule H ................................................................................. 62
63 Add lines 57 through 62. This is yourtotal tax ....00...0000.....................00..... .................................... ~ 63 89.606.
Payments 64 Federal income tax withheld from Forms W-2 and 1099 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64
65 2005 estimated tax payments and amount applied from 2004 return ........... . 65
If you have 66: ~:~:::~I:o~~~~~~:~~I~~t;~.~"::.:::: .:...~.. r .~.~~. r................................ 66a
a qualifying
child, attach
Schedule EIC. 67 Excess social security and tier 1 RRTA tax withheld (see page 59) 67
...............
68 Additional child tax credit. Attach Form 8812 ............................................. 68
69 Amount paid with request for extension to file (see page 59) ............... H....... 69
70 Payments from: a D Form 2439 b DForm 4136 c DForm 8885 70
71 Add lines 64 65 66a and 67 throuah 70. These are vour total Davments ......... ............. H.................. ~ 71
Refund 72 If line 71 is more than line 63, subtract line 63 from line 71. This is the amount you overpaid .00......... ......... 72
Direct 73a Amount of line 72 you want refunded to you .00....................................... ~ 73a
deposit? Rou~ng I I D 0 Accoun,t I ..... ....... ..... .. ................
See page 59
and fill in 73b, ~ b number ~ C Type: Checking Savings ~ d number
73c, and 73d. 74 Amount of line 72 vou want aDolied to vour 2006 estimated tax......... ~ 74
Amount 75 Amount you owe. Subtract line 71 from line 63. For details on how to pay, see Pjge 60 r- . . . . . . . . . . . . . . . . . . . . . . . . ~ 75 90.071.
You Owe 76 Estimated tax Denaltv (see Daae 60\ HHHH ..... . ...... .. .... 76 465.
Third Party Do you want to allow another person to discuss this return with the IRS (see page 61)? [X] Yes. Complete the following. D No
Designee Designee's..... PRE PARER Phone..... Personal identification.....
name ...... nO. ...... number /PINJ ......
Sign Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are true, correct,
and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Here Your signature Date Your occupation
Joint return?
See page 17.
Keep a copy
fo< your
records.
.-....#...ilL-:ua.1! '\!!IrA.. '" .......~....-.l......,.;,......~ . .~ .-. ....;.;M.-~- .......
..
..
, .
Form 1040(2005) LISBETH E
SHELLEY
I
I
I
I
~ Spouse's signature. If a joint return, both must sign.
HYSICIAN
Date
Spouse's occupation
I
Date
Paid Preparer's
Pre parer's signature
Use Only Firm's name (0<
yours if self-em-
510002 played), address,
11-05-05 and ZIP code
~
~
& COMPANY
SUITE 101
,
,
--,_.~
206-36-2401
Page 2
Daytime phone number
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0500110168
L
I
PA-40 - 2005
Pennsylvania Income Tax Return
ENTER ONE LETTER OR NUMBER IN EACH BOX.
Do Not Use Your Preprinted Label
I
20636240:1.
N
Extension.
I
SHELLEY
N
Amended Return.
LISBETH
E
Occupation PHYSI ClAN
R
Residency Status.
PA ResidenVNonresident/Part-Year Resident
from to
I
Occupation
S
Single/Married, Filing JointlylMarried,
Filing SeparatelylFinal Return/Deceased
Date of death
I
I
609 DEVONSHIRE DRIVE
CARLISLE
N
Farmers.
PA
17013
I
21110
I
I
10 Medical Savings Account. CAUTION: See the instructions. Enter the amount from
your Federal Income Tax return. Do not deduct medical expenses or insurance.
11 Adjusted PA Taxable Income. Subtract Line 10 from Line 9.
1a 0
1b 0
1c 0
2 43
3 515
4 0
5 452640
6 0
7 0
8 0
9 453198
10 0
11 453198
1a Gross Compensation. Do not include exempt income, such as combat zone pay and
qualifying retirement benefits. See the instructions.
I
1b Unreimbursed Employee Business Expenses.
1c Net Compensation. Subtract Line 1b from Line 1a.
I
2 Interest Income. Complete PA Schedule A if required.
3 Dividend and Capital Gains Distributions Income. Complete PA Schedule B if required.
4 Net Income or Loss from the Operation of a Business, Profession, or Farm.
I
I
5 Net Gain or Loss from the Sale, Exchange, or Disposition of Property.
6 Net Income or Loss from Rents, Royalties, Patents, or Copyrights.
7 Estate or Trust Income. Complete and submit PA Schedule J.
8 Gambling and Lottery Winnings. Complete and submit PA Schedule T.
9 Total PA Taxable Income. Add only the positive income amounts from Lines 1c,
2,3,4,5,6,7, and 8. DO NOT ADD any losses reported on Lines 4,5, or 6.
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574001/12.08.05
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0500110168
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0500110168
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