HomeMy WebLinkAbout05-30-07 (2)
CHARLES E. SHIELDS, III
ATTORNEY-AT-LAW
6 CLOUSER ROAD
Corner ofTrindk and Clouser Roads
MECHANICSBURG. PA 17055
GEORGE M. HOUCK
(1912-1991)
TELEPHONE (717) 766-0209
FAX (717) 795-7473
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15056051047
REV-1500 EX (06-05)
PA Department of Revenue *'
Bureau of Individual Taxes .
PO BOX 280601
Harrisbur ,PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Date of Birth
Suffix
MI
[f]
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
_ 1. Original Return
c:::J
4. Limited Estate
c:::J
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
c:::J
2. Supplemental Return
c:::J
-
c:::J 4a. Future Interest Compromise (date of
death after 12-12-82)
c:::J 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
c:::J 10. Spousal Poverty Credit (date of death c:::J 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 Da ime Telephone Number
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
JL
8. Total Number of Safe Deposit Boxes
c:::J
L.'
C)
I')
be
ix.net
en
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Correspondent's e-mail address:
~11 /7~1
DATE
Side 1
L
15056051047
15056051047
....J
-.J
15056052048
REV-1500 EX
Decedent's Name: L A /tit. Y 1.. ale" II' ~
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) <:::) Separate Billing Requested . . . . . .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) <:::) 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 .OI:L
16. Amount of Line 14 taxable
at lineal rate X.O ':t.S.
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . , 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
L
15056052048
Decedent's Social Security Number
15.
16.
17.
18.
-
15056052048
-.-.J
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
(;r/.u Vr::~1 LA-AllY L.
STREET ADDRESS
Sf SS HI LLSI./JE LA1/E
File Number ~/-o'- 8'0/
CITY
IH C:CN A N/tl. S /lJt( Il&
STATE ;tJA-
ZIP/
70S?;
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
()
o
f 1./'.2.'1
#/A
.
Total Credits ( A + B + C ) (2)
~9# 29
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( 0 + E )
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.
o
o
(3) ()
(4) of'i'I. z?
(5) 0
(SA) t?
(5B) ()
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
t1li!i1liI__~
~;
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 ~
b. retain the right to designate who shall use the property transferred or its income; ............................................ D 181
c. retain a reversionary interest; or.......................................................................................................................... D ~
d. receive the promise for life of either payments, benefits or care? ...................................................................... D ~
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. D ~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ ~ 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. ~9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent
[72 P.S. ~9116 (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 return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. ~9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in
72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1}].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. ~80601 .
HARRISBURG. PA 17128-0801
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
SPOTTS WILMA M
71 BIG OAK ROAD
DILLSBURG, PA 17019
-----..-- fold
ESTATE INFORMATION: SSN: 202-46-5093
FILE NUMBER: 2106-0801
DECEDENT NAME: GRUVER LARRY L
DATE OF PAYMENT: 11/1 3/2006
POSTMARK DATE: 11/06/2006
COUNTY: CUMBERLAND
DA TE OF DEATH: 08/24/2006
NO. CD 007427
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
06154033 I $49.29
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 1612
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
$49.29
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REV-150~ EX+ (6-9*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
'-R.U V~~, LA/lAY L.
FILE NUMBER
~/- I> , - 4'01
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.
VALUE AT DATE
DESCRIPTION OF DEATH
~l.l -r1IA-r (!.E,er AlAI LoT DF CH!IJuAlD tMfJIZoV6.:D
l3y A- ./)(gFUlN6 N~kSE SI7u,f7C "'-7 S85S
HlLl..5IDE L.AKE" f/,fm/JIJEN 'h1tJ";JI/II'., A1etJNAMt!.S~
8 U/t.6, e.ltllf b3tLAIV IJ ~t{"'~ /lEd#' A-.
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.])/I-j// lJ (!, LJEYIP / "F C!.A-IeJ.IE'E, /1G7V#~ ,
5677ZE',#1#NT Neu ~A/ /Y//~ /1; ~~~
(SEE SGrr~E/J(~ SHE~T ""~~&;Z) '8~SS7J.ID
#E1ft.c-n)
TOTAL (Also enter on line 1, Recapitulation) $ 8' L/J S-!>"~... dD
(If more space is needed, insert additional sheets of the same size)
.......,
.....
OMB NO. 2502-0265 -fr
A. B. TYPE OF LOAN:
. 1.DFHA 2.OFmHA 3. ~CONV. UNINS. 4. OVA 5.OcONv. INS.
U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 6. FILE NUMBER: 17. LOAN NUMBER:
SETTLEMENT STATEMENT AS 2006-059 047-156267-8
8. MORTGAGE INS CASE NUMBER:
C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked 'TPOCj" were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
1.0 3/98 (AS 2006.o59.PFD/AS 2006.(59/41)
D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER:
Estate of Larry L. Gruver, Homecomings Financial
David C. Deyo Wilma M. Spotts, Executrix 9 Sylvan Way, Suite 310
933 Forest Court 5855 Hillside Lane Parsippany, NJ 07054
Carlisle, PA 17402 Mechanicsburg, PA 17050
AS06-059
G. PROPERTY LOCATION: H. SETTLEMENT AGENT: I. SETTLEMENT DATE:
5855 Hillside Lane Atlantic Settlement Group, LLC
Mechanicsburg, PA 17050 November 17, 2006
Cumberland County, Pennsylvania PLACE OF SETTLEMENT
300 North Second Street, Suite 900
Harrisburg, PA 17101
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
100. GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER:
101. Contract Sales Price 84,550.00 401. Contract Sales Price 84,550.00
102. Personal Prooertv 402. Personal ProoertV-
103. Settlement Charaes to Borrower (Line 140m 6,081.40 403.
104. 404.
105. 405.
Adiustments For Items Paid By Seller in advance Adiustments For Items Paid Bv Seller in advance
106. CitvlTown Taxes 11/17/06 to 01/01/07 2.24 406. Citv/Town Taxes 11/17/06 to 01/01/07 2.24
107. CountvTaxes 11/17/06 to 01/01/07 13.68 407. CourrtVTaxes 11/17/06 to 01/01/07 13.68
108. School Taxes 11/17/06 to 07/01/07 298.80 408. School Taxes 11/17/06 to 07/01/07 298.80
109. Sewer/Trash Charaes 10/01/06 to 11/17/06 63.35 409. Sewer/Trash Charges 10/01/06 to 11/17/06 63.35
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 91,009.47 420. GROSS AMOUNT DUE TO SELLER 84,928.07
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
201. Deoosit or earnest monev 1,000.00 501. Excess Deoosit (See Instructions)
202. Princioal Amount of New Loan(s) 67,640.00 502. Settlement Charoes to Seller (Line 1400) 6,598.50
203. Existino loan(s) taken subiect to 503. Existino loan(s) taken subiect to
204. 504. Payoff First Mortgage to MERS Decision One 76,414.25
205. 505. Pavoff Second Mortoaoe
206. Proceeds from Hud 1A 15,814.61 506. Escrow for Inheritance Tax 1,915.32
207. 507. CDeoosit disb. as oroceeds)
208. 508.
209. 509.
Adiustments For Items UnDaid Bv Seller Adiustments For Items UnDsid By Seller
210. Citv/Town Taxes to 510. CMown Taxes to
211. Countv Taxes to 511. CountvTaxes to
212. School Taxes to 512. School Taxes to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PAID BYIFOR BORROWER 84,454.61 520. TOTAL REDUCTION AMOUNT DUE SELLER 84,928.07
300. CASH AT SETTLEMENT FROMITO BORROWER: 600. CASH AT SETTLEMENT TOIFROM SELLER:
301. Gross Amount Due From BorrowerlLine 12m 91,009.47 601. Gross Amount Due To Seller (Line 420) 84,928.07
302. Less Amount Paid By/For Borrower (Line 220) ( 84,454.61 ) 602. Less Reductions Due Seller (Line 520) ( 84,928.07
303. CASH ( X FROM) ( TO) BORROWER 6,554.86 603. CASH ( TO) ( FROM) SELLER 0.00
The undersigned hereby acknowledge receipt of a completed copy of pages 1 &2 of this statement & any attachments referred to herein.
Borrower V~C ~~
David C. Deyo
~I~ :;;~?Z:fr#:'
L. SETTLEMENT CHARGES
700. TOtAl." COMMISSION Based on Price $ 84,550.00 @ 6.0000 % 5,073.00 PAID FROM PAID FROM
Division of Commission (line 700) as Follows: BORROWER'S SELLER'S
701. $ 2 586.50 to Jack Gauahen ERA- GAUG12 FUNDS AT FUNDS AT
702.!l; 2486.50 to Exit Realtv CaDital Area SETTLEMENT SETTLEMENT
703. Commission Paid at Settlement 5.073.00
704. Transaction Fee to ERT- NRT, Inc 165.00
SOO.ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Oriaination Fee % to
802. Loan Discaunt % to
803. Appraisal Fee to Robert Bolash POC:B300.00
804. Credit ReDort to
805. Broker Oriaination Fee to Comfort Home Mortgaae, LLC 1,197.03
806. Lender Loan Charge to Homecamings Financial 665.00
807. Broker Processing Fee to Comfort Home Mortgage, LLC 650.00
808.
809.
810.
811. Broker Fee from HF to Comfort Home Mortgage POC:L26.38
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From 11/17/06 to 12/01/06 @ $ 11.582100/day ( 14 days %) 162.15
902. Mortgaae Insurance Premium for months to
903. Hazard Insurance Premium for 1.0 vears to The Travelers Indemnity Companv 486.00
904. Flood Insurance 1.0 years to Travelers Flood POC $887.00B
905.
1000. RESERVES DEPOSITED WITH LENDER
1001. Hazard Insurance 3.000 months I $ 40.50 ner month 121.50
1002. Mortaaae Insurance months ( $ per month
1003. CityfTown Taxes 11.000 months ( $ 1.66 Der month 18.26
1004. CountVTaxes 11.000 months $ 9.16 per month 100.76
1005. School Taxes 6.000 months @ $ 41.66 per month 249.96
1006. Flood Insurance months Ci $ per month
1007. Flood Insurance 2.000 months (, $ 73.92 oer month 147.84
1008. Aggregate Adjustment months Ci $ per month -137.66
1100. TITLE CHARGES
1101. Settlement or Closing Fee to
1102. Abstract or Title Search to
1103. Title Examination to
1104. Title Insurance Binder to
1105. Document Preparation to CT Land Services Company 500.00
1106. Notarv Fees to Notarv 49.00 15.00
1107. Attorney's Fees to
(includes above item numbers: )
1108. Title Insurance to Atlantic Settlement Groue. LLC 761.06
(includes above item numbersEnhanced- reissue )
1109. Lender's Coverage $ 67,640.00
1110. Owner's Coverage $ 84,550.00 761.06
1111. Endorsements to Atlantic Settlement Group, LLC 200.00
1112. Closin9 Protection Letter to First American Title Insurance Company 35.00
1113. Courier, Wire and Email Fees to CT Land Services Company 95.00
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recarding Fees: Deed $ 38.50; Mortgage $ 66.50; Releases $ 105.00
1202. CitvlCountv Tax/Stamps: Deed 845.50' Mortaaae 422.75 422.75
1203. State Tax/Stamps: Revenue Stamps 845.50; Mortgage 422.75 422.75
1204. Home Inspection to Advance Look 325.00
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Survev to
1302. Pest Inspection to
1303. Reimbursement for Tax Cert to Atlantic Settlement Group, LLC 5.00
1304.
1305.
1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Section K) 6,081.40 6,598.50
Page 2
.--
By slgmng page 1 of thIS statement. the Slgnatones acknowledge receipt of a completed copy of page 2 of thiS two page statement
Atlantic Settlement Group, LLC, Settlement Agent
Certified to be a true capy.
( AS 2006-059 / AS 2006-059 /41 )
..
HUD 1A OMS NO 2502 0491 "...
- - ...~r'
A. . U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT
SETTLEMENT STATEMENT
, Optional Form for Transactions .,.;thout Sellers
NAME AND ADDRESS OF BORROWER: NAME AND ADDRESS OF LENDER:
Homecomings Financial
David C. Deyo 9 Sylvan Way, Suite 310
933 Forest Court Parsippany, NJ 07054
Carlisle, PA 17402
AS06-059-1
PROPERTY LOCATION: SETTLEMENT AGENT: Atlantic Settlement Group, LLC
5855 Hillside Lane PLACE OF SETTLEMENT: 300 North Second Street, Suite 900
Mechanicsburg, PA 17050 Harrisburg, PA 17101
Cumberland County, Pennsylvania
SETTLEMENT DATE: November 17, 2006
LOAN NUMBER: 047-156344-5
L ~"'TTL "'."::"'T M. DISBURSEMENT TO OTHERS
800. ITEMS PAYABLE IN CONNECTION WITH LOAN 1501. Proceeds from Hud 1A to
801. Loan Oriaination Fee % to Proceeds to Hud 1 15,814.61
802. Loan Discount % to 1502.
803. Aooraisal Fee to
804. Credit Reoort to 1503.
805. lender's Inspection Fee to
806. Mortaaae Ins. ADD. Fee to 1504.
807. Misc. Mortaaae Broker Fee to Comfort Home Mortqaqe, LLC 592.00
808. 1505.
809.
810. 1506.
811. Broker Fee from HF to Broker to Comfort Home Mortaaqe, llC POC:l42.28
812. 1507.
813.
814. 1508.
815.
816. 1509.
817.
818. 1510.
819.
820. 1511.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest 11/17/06 to 12/01/06 flU $ 4.134800/dav 57.89 1512.
902. Mortnaoe Insurance Prem for months to
903. Hazard Insurance Prem for 1.0 yrto 1513.
904.
905. 1514.
1000. RESERVES DEPOSITED WITH LENDER
1001. Hazard Insurance months oer month 1520. TOTAL DISBURSED 15,814.61
1002. Mortnaae Insurance months oer month (enter on line 1603)
1003.CilvlTown Taxes months oer month
1004.CounlvTaxes months oer month
1005. School Taxes months $ per month
1006. months $ oer month
1007. months 9) oer month
1008. months $ per month 0.00
1100. TITLt: cHARGES
1101.Settlement Fee to CT Land Services Company 100.00
1102. Title Search to
1103. Title Examination to
1104. Title Ins. Binder to
1105. Document Preo. to CT Land Services Company
1106. Nota-r.iFees to Notarv 35.00
1107.Attorney's Fees to
{includes above item numbers: \
1108. Title Insurance to Atlantic Settlement Group, LLC
{includes above item numbers:
1109. Lender's Coverage $ 16,910.00
1110. Owner s I.;;overage $
1111. Endorsements to Atlantic Settlement Group, LLC 200.00
1112. Closino Protection Letter Atlantic Settlement Grouo. LLC N. NET SETTLEMENT
1113. Courier, Wire and Email Fees to CT Land Services Company 62.00
1114.
1115. 1600. Loan Amount $ 16,910.00
1116.
1117.
1118. 1601. Plus Cash/Check from $ 0.00
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES Borrower
1201. Recording fees: Mortaaae $ 48.50 ; Releases $ 48.50
1202. Citv/Counlv Tax/Stamos: Mortgage $ 1602. Minus Total Settlement $ 1,095.39
1203. State Tax/Stamos: Mortaaae $ Charges (line 1400)
1204.
1205. 1603. Minus Total Disbursements $ 15,814.61
1300. ADDITIONAL SETTLEMENT CHARGES to Others (line 1520)
1301. Survey l/:
1302. Pest Inspection 1604. Equals Disbursements to
'no~. Borrower (aft~ expiration
1304.
1305. yapplica Ie r~rssion
1400. TOTAL SETTLEMENT CHARGES (enter on line 1602) 1,095.39 peri~ reqUir~ by I S'b
The undersigned hereby ackno.,.;edge receipt of a completed copy of this statement & any attachments referred to herein. /) U V /
Borrower ~C. --() ~ V,---
Atlantic ettleme "f;. LL \ I
David C. Deyo Settle ent Agen
Certified to be a true copy.
\)
Form HUD-1A (2/94) ref. RESPA
1.0 04-98 (AS2006-059-1/ AS2006-059-1/22 )
_~a.",". *'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF Gl.<<. tlEI<J L. t/.~y L.
FILE NUMBER
r2/-~, -3t;/
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
,to
.3.
~
DESCRIPTION
rrGIfIS of t!AlEtJlT tJN 6GrTl.EhISIT ~~ ,SA-t.t!F of
~EIH. FS7if'Tl: ~9 St.: 7"T~I!F/J(cNT ...9-/~T A-TT~-
~ 7; StLl/EOt/L.F A-:
0.) L,'N W'- ~ /WA 74,~es
h). t./ltt. 'f07- &Jt/Jr ~es
C.) I../Ilt l/I/- St!hIJ()/ /~e6
/.) L,'/Ie. /fP9- ~e.r/~Sh CA.trfes-
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f7&1Jf L€F6ra ,l:}If,IJG. / /N'(!...1 ()F Z>/LL.SS V,f!(;J to/l)
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J
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A--rrA (!.1{Gt))
..
f'E!eSIM/If'{.TY ,an vA-L.U/l-7//;M ~11I /.&8$ tf)ttrlJ~f)J:2
/fJU)lrle, /N~., /f N"/f(!'HElJ 1i4Hl~:
q.) >:trll' 1Jtad,/"e 3. S fill tpush /)'Lt:JuJU"
h..) /lte,.ra, Ie/d,"'! /111111tr (fI~Stf)O.J) IIf.S #1' ~2'~ etd;az.
~ .) I/DlHeI:fe. 7'r/III/lfer
fJlU't/ld /(efund f.,-DI1t H{)rnef!IJfH;~ 5 HJ1tutG,'ctI, A- GmM.
U;NpIUZ,y I tlS ~r'r!;lJa{ /~Ildtr tlJlJ ~I'~~ #a/lo - Escrow
fJ~rf/1i1 ldurv/ m"" 7k 1J,g))/'i.sts z,su/,fIM,C./l ~L<.fO
/krf" 6,/ Rdz,lIl1l /rrJAI &p,'W /3/ ue ~!oS
/99~ t/J(J.r/'~/d- S!.~/ .sol~ ~ A/all L't)toa.nre..
VALUE AT DATE
OF DEATH
"~..'l"
~3. iJa
fI
.2 '1'. 1ft)
,11 (, ~. ~5
tf
2, /8 s:. fX)
'Iff. 'If
J,u.1t. valu.e
~.D()
'5b,f)O
',2~t3.I;z,
., 5z. '1#
~ Istf" 3S"
,
/} (JDO. DO
~,
7.
s:
(Qe. 4Dq.r,illltl h'4n shed)
TOTAL (Also enter on line 5, Recapitulation) $ II,' 101, 3{,
(If more space is needed, insert additional sheets of the same size)
, SC/-IFlJ. F. / tJlI~')tlleoll ~ 2-
I €.57. t>t= t;.f2J{fni~LA&/lY L. I=illF~. 2/- oj, -g.OI
9 .\:{t~'!f .. &,fIIlA-Ityftl-f2ltrBf/4flh ~.1:. 1'1 iU{Ul1lLUU:/ m
........\Mmwt .tIAt!!fl'" . !t!l!/I~'Ilf/'aOJeLlts ~'rU1 ,/;. .~",..?t/l}t~&I.
.. r91lJl JlEte :
Hi ^---'~-" ."-
" __+_m ,(.j :<7' S~<J1 7"1"__ ~ _ _~liJ:tJ!k",_;"ir "~,,""
._____.._______.._+__, _t1.i_~l~_J.~e.!l-[~=-. _'!~t/ ~~~~_~~r/~'YL,-
: (!,) /J Jll!i!!"ft./' ~_","e!r!!~~~6-"
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. --.-\- ._5!fdu-::-.MIAHt.lf.IIIPI:if.
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I (;)~/;lia€$Y:_~ JUJ!UfJ..J4~--- -
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r Pluff N'ffi : ()IIAI do" MIt. sft-k del';1f tl .6<<;tIc...,;'
+lv/'ic/jt/J5 .wy 1P(J~w.{Ptf!P//ce"
I
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11v:II1fASft-tIi ~~~:
I ,(,) ..5#;,.;., ~Jrd _
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I
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Ii J.) hi,' S~. IlsSDrfe~ k,'/-c.lu.1l ; ~5 a.i IAiItnS:tS ~f). 00
1
1
,
,
i
I SCHED. F. J fUJn f,'nu.ul, tJllf 3
I
.,~.j.S,S7:H ;@fj/E71/~~~Y.L.~. '. ..~~B(~():~:~R~..............~QI...
. IleoJs 1If. ./l!dNl~/Y ...... ~._~~/L ...~. ...J..~.....t..~...L..--'Y.1L;..u
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.. ...JJ~.I 7t~q.1!1./Jtl';S!M~~f1tL~LYIfJ/t.-_~:1E.....~.... ~,-I!//~t If.. ~t''!:J''~C_.u___...__._
.-.--..--.- .- .....Lt.._I!li~~el/(-'"!~!.I!s._._d.~_~_cd1__.~ci!.!t1~__(?/~.,t?~!!!l}r__&&!L~.. _. ...___________...._....___.._
._ -d!/!!!.~~...~r.,,-~{--,:!:il/!y-',_,____, ......__..___. .. ....______._.~'7t!;~~_.__.____
......_li___/MJ!f:~b/I!__~_ -!2"1-IM~!e..~-~._~...rZE_.iS~~_ ..____________. ... ______
- ...~__~_+f,."'M-~~-:td/.I,"'....~ -.._~_ ...~~_~_. .........~~~... ..... -~__~._~_._m~
_. - _..__ .___.____j. ..__ . .______.__... . _. . .. .__ _.._______M_ .__. ...._ _.......,__,.___.._.__......_..____.__.___.__.._._____ _.....__.___ -.-.""---..-..----.----------. ,__..__.____.
. .. j.r~. ~~~"'.t. ~.~...J,..~.fri.....~.....!~ <o-"!'lI!j'I?1.+:,QItb.1 /'t1'.,f.J'i!P~:: ISL:~_ ~
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...~. ..11.. ...~~~~~~~=~-~~~...=-~..~=....~-~~~~-.....----=?D~~~;~=
If. ReilHburslIJtU1j /J/ue eroSJ , 2//. ;''1
."-..... -., u., ...'--.---.--.----....'7.--...-.-.-..-.. '.'''U_'''__''',_',. .U".__.._ . .._.
.. .lr....i..f!~~!!IlcLJJ~~__~n.,.(jl!1f.4st ......._ .....___......... ....__......... ~YtJ./:t,
...tir>.=_ _..__If~l~~'!:.~_._I}!~f.._~$>_,,_____,., ... ... --________'-'iZ.k~_..
- ~!L_...l!t.cf.((~!! _____._____._ .__ u..' '.. __~{?l,??._._
;};l 11?$.~I{#.!?, ~,2_ZZ. {')r;
LEFEVER BROS., Inc.
...
Phones (717) 766-9582 . 432-9611 - Sales
697-5479.432-9697 - Parts
406 U.S. 15 North
P.O. Box 660
DILLSBURG, PA. 17019
JI ':(9' 7
'j" /
1 L-L\-Ob
11-. e.. '1f"~' Je.... 1" ~ ""'-1Jv\J-- "...Q ~ '"& ~ \ VI 'b
~.At ~ c... G...-~ ..t\VV\- 4; rl1fV\., S~ ~4-- () \AJ '^~ ~ ~ 1) -( ~ A..-\ G- v \,1 \ItA.-
J I J
w",h-. ~{'<.~JJ\ \O\n1b ~-,\u... :'1'] j$215~';: ihrs ,,~k 1$
\, ~ S ( C () '" lit \ \ ~\ 1>l"W:- 130 D It.., V k l---e- Jv ... ~;-s " e.-ki c- k- j 1'\ ~ ~d J
C C1 ,..,J ~ H """
.
<;;"L~_ 111
GM"1 &/w~
Date: 11-14-2006
www.haat~s.com
Settlement
Seller: 71
It em
':...
HAAR'S AUCTION SERVICE
WILMA SPOTTS
CK TO LARRY GRUVER EST.
71 BIG OAK RD
DBG PA 17019
Des Ct"' i pt ion
Box lot
Box lot - cassettes
Tacklebox
Box lot - cleaning - paints
Boom box 0 sleeping bag -
bedding ':;
Box lot - heater - blanket
M ict~o ph on e s
Box lot - cups- dishes-
bowls
Box lot - books - puzzels
Box lot - baking pans -
a I urn.
Box lot - blanket - griddle
- pans
Al urn. yard st ic~(s
Box lot - heater - baskets
Cooler
Box lot - pruners -
Indaian blankets
Box lot =- blankets -
batht~oom set
Fishing pole - net
Raft - t'_lbes
Box lot - electronics
Bed tray = wall shelf
I'Jggage
Powet' amp
Tt~ussels
St 00 1
Stoye
Folding table
M it~t~Ol"~
Axe-chair
Tool box
Umbt'ella
Speaker-stool-crate
Box spring-mattress
Coffee table
Floot~ lights
FlOOl^ light
2 chairs
Bed frame
Step laddet~
Stand
717-432-8246
Pr"' i ce
17.00
Qty
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
c:
1
1
1
1
1
1
1
Page:
1
Total
1. 50
2.50
1. 50
l.00
0.2500
0.2500
10.00
0.2500
0.2500
0.2250
9.00
0.2500
2.50
0.2500
0.2500
3.00
0.250121
2.121121
4.00
3.0121
121.2500
17.1210
3.00
1. 00
l.00
17.00
1. 121121
121.25121121
1. 5121
2.121121
121. c~5121121
34.121121
3.0121
121.251210
121.75121121
2.121121
1121.121121
1121.121121
121.5121121121
@
Date: 11-14-21211216
www.haat~s.com
Settlement
Sellet~: 71
Item
HAAR'S AUCTION SERVICE
WILMA SPOTTS
CK TO LARRY GRUVER EST.
71 BIG OAI-{ RD
DBG PA 1712119
Desct~i pt ion
717-432-8246
Pt~ice
Qty
Page:
2
--------------------------------------------------------------------------------
Total
www.haars.com
Lamp table-ca\'~t
Desk
Wooden cases-shelf
Microwave cat~t
Fan
Book case
End table
Cat toy
Whee 1 ba'r~row
Shelf
Commission at 4121.1211211211-
Items:
49
Amount:
75.99
Less adjustments:
Net due to seller:
HAAR'S AUCTION SERVICE
717-432-8246
1
1
1
1
1
1
1
1
1
1
5.121121
6.1210
3.00
7.121121
121.5121121121
4.121121
3.121121
5.121121
8.121121
1. 50
189.98
-75.99
113.99
QUALITY SALES AND SERVICE
~~ our PartJ1er 111 The Outdoor Cl1allenge'
INC.
PHONE: (717) 292-3640 - FAX: (717) 292-9553
640 ALPINE ROAD, AT PINCHOT PARK, LEWISBERRY, PA 17339
December 22, 2006
To Whom It May Concern:
Below please find a list of equipment and their approximate
values:
Yard Machine 3.5 HP push mower w/ 20" cut: UNIT HAS NO
VALUE... JUNK
Murray Riding Mower (425003), 14.5 HP 42" cut: UNIT DOES
NOT START, HAS NO BELT AND DECK IS RUSTED: $50
Homelite Trimmer: $50
Sincerely,
Blaine N. Rentzel, President/Owner
YOUR COMPLETE LAWN AND GARDEN EQUIPMENT CENTER
SALES - PARTS - SERVICE
http://bobmower17339.tripod.com
,..
"'I'~~('I.'"'Ut::a~.':I......~:t;:(jf~"'lkll.~~'.I1I]I..,..~...."f::i~r~ml.I:I:41'I'~':::I:tl'I"':I~"lll{:I:I~.:1:I...II..It1:...,.
',';.:.:,'J;
;i ",. . ," ..';;:;',;~;',.-
;?~i5::~:~~i?::,::N:.;
6 n'iAicirnio:o
'c.tt:~\) 't)':,,;
xf
HQJtl.e~~lJ!ttgs;'*.P..'.'a.ncial
'A GNIACComparw' .... . ..... ....
Well> Fargo Blink
PAY
Lar;y L.Gruver
,,71 ,BJ.goak Road
JRA-:L1:$~'ll~.qjPA :1;7019.,
, ;, -,:,,;-,_,,:,.,";:.c,;:'_':.>.-:":;i,-;
:,;~;~~:rt:t~(}};;?, '7~"':':':t.~::-,~~:~.:~'< -'~~'
: . ....
H'E. 2"'E.Oqa,,' ':0... ~ 20:18 ~"I: qE.OOO'" ?...q Sill
QETII..CH Al-jD RnAll'HHIS STATEMENT
omecomings Financial, Cityplace Center: 27 ] I N. Haskell Ave., Suite 900, Dallas, TX 75204
NO.
6246098
DATE LOAN NUMBER NAME
12/19/06 0437455363 Gruver
POLICY NUMBER OR TAX ID
L
AMOUN'I
222.12
In tJ ( "L ~
v..ri~ ' pV') \
'I^- ,,~4 ,rf jll-C l r
I 1/1.-1 r 7
l./Y'" );;'C;;)6 b/
\~
.- ----..:....---.- ..-----.----.---------.....---
CLEARING ACCOUN'
~,' ~ :1,The :MotOrists ;1~sur~Ace
II" Group,Youknowus.
DATE
MUST BE CASHEDW1THIN
180 DAYSo'\FTER ISSUE
~2:.I!_Ol./~~06. ~ir
~74420
.... NATIONAL CITY BANK
ASHlAND, OHIC)
56.389
412
. (.. <::,.
Z332-06-BtiJ9~41'7P3;
,f-.PPL!0A'11!PN OR POLICY NUMBER
,roo. 474 4'2 0
AMOUNT. .
$i5?~/fJ4
..-.'.' ;,. .~':.,
;:"'\'jo"-,:' : '.
, }':-.;'
:F"I'FJ:'Y-J"'WO iA ND:94il~:Q. .!2._~:...~.:::.:.:.._____ -'~T::T:G'T:J:._r:.};..- --------- -- -- -7~[)OLLARS
i"S.::':.',
.,,..:.'1".:: ". ~;'.f;
5855 HILLSIDE LN
TOTHE LARRY L GRUVER
lRDER.OF
121 10-04
MECHANICSBURG PA 17050
1I1L.7L.L. 20111 1:0....20:38/151: O.b 2 .b5111
,<'..,:. ,...."
'-. ";'"
." ,/AUTHORIZEDSIGNATURES
.: 11:11 ~'I"l,.::t:II'J "1:1~.::I'. :l1':I::I:_ .J..~I.. .,1' ~ 11::1 ~ .'1'1. ~: I.]...~ 1'1I.1~ 181.: l::alf: '1' I ~I.I ~I~.'I"!~.::I :f~" 'I':J ~~ 11): I :(Ii~.: r!l--W:I.:I"J =-:,., tj~. ~ :1.] Il~l.
~:,*~~m~~
Independent Ucensees of the Blue Cross and Blue Shield Association
CHECK NUMBER:
)ij~05Q~4;83Si
i!gt05/Q6
62-4
311
PAY TO THE ORDER OF:
LARRY L. GRUVER
71 BIG OAK RD
DILLSBURG, PA 17019-9122
VOID. AFTER 180 DAYS
1051-02
CHECK
AMOUNT:
**********$158.35
1111111,"111111111111.1..1.11111111"1.11.1.1111.11111111...1
III 2050 .l.8 :l8111 1:0:l. .000 l. 71:
2 III g b b l.. l. III
~,~.."" .
COMMONWEALTH OF PENNS) LVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATEOF CRLlVE)(, LA~~Y L.
SCHEDULE F
JOINTLY-OWNED PROPERTY
FILE NUMBER
.21- /), -tfol
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
RELATIONSHIP TO DECEDENT
ADDRESS
A. WI L.1t1'+ m. S f'o,-rs
B.
c.
i, SIcS- OAK R.D.
"J)ILL$Su~6." PA- 17t)Jq
/
s J.\.T~
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 identifying number. Attach DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT deed for joinUy-held real estate. VAlUE OF ASSET INTEREST DECEDENT'S INTEREST
1, A. -r/rz./os MEM8EJtS ~T Fri> . CfeEPJT u.J\I/!lN R8;1.(-
t..Ihf S A-Y'JII6 $ ~,:r: N~. :/,'77'7-00 . I ,;?.s: bO
'Pit., AJ e,plrt. SIrL. ., is. DO ;J$. DD St}~
,,1. A. 1 J,.z./~ ntElUSIff/tt J~T R!!D. C/b:!>IT UNlDN CNtitJt.
/11/6 A-eer: N~. i:lh776,7-/1 , ~ ,
(JAINe,,rI/H. 18~. ~8"'I. '3 8' 9: ,:5 '1-32.32
, {:ieL VIl!f,lQ ~D" /e/h,r {rDM /J1eMkr.s 1st L#- J&~S 7, 3Z
a eJttJ h ereib)
TOTAL,(Also enter on line 6, Recapitulation} $ Jf 57. 3 t...
(If mnrp. ~nAr:P. Ii': nP.P./'lFlli. inAArt MnihnRRI i':hp.p.t~ nf!hP. ~RmP. ~i7p.'
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
Date Joint Ownership Established
CHECKING ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
Date Joint Ownership Established
CHARGED-OFF LOANS:
Account Number/Suffix
Date Certificate Established
Principal Balance at Date of Death
Loan Type
*Discharged through bankruptcy
Estate of: LARRY L. GRUVEN
Date of Death: 08/24/2006
Social Security Number: 202-46-5093
fvl~
MEMBERS 1st
FEDERAL CREDIT UNION
267767-00
07/12/2005
$25.00
$.00
$25.00
Wilma M. Spotts
07/12/2005
267767 -11
07/12/2005
$864.63
$.00
$864.63
Wilma M. Spotts
07/12/2005
114826 -07
01/25/1995
$2,095.01*
Unsecured
114826 -08
06/29/1995
$162.95*
Unsecured
Mff~R~SST F DERAL CREDIT UNION
M~ .~:t::
Denise A. olfe
Insurance Services upervisor
January 31,2007
5000 Louise Drive * P.o.Box40. Mechanicsburg,Pennsylvania17055. (717)697-1161. www.members1st.org
~....,.... '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF GIf!.UYI=7eJ LA-te,ey L..
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
~o,- 8'01
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.
ITEM
NUMBER
1.
DESCRIPTION OF PROPERTY
INCLUOE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO OECEOENT AND THE DATE OF TRANSFER.
ATTACH A COPY OF THE DEED FOR REAL ESTATE.
FD/I. IAlFc/l,lHII-71~/11 J'7UI2P()SES: O€"Cb""'b6UT ~
5'2. y~ ot.LJ A-r7r/e dA1& ~I= M'S ,(}GlF~.
fiG" NAI) ,,4 ~PI{K) 7H~Hcn' #/.5" C1Jtf:lU;yg)
I~V &;h1IHJ(AJle""'TI~))s;. /A/t!. ~#/t!H H/~
Wcz...o A-A;iJ A-tJ/J(/A//S7t7ZC'b /By IAI.re:s1JJA1tf.
.
VE.sTt!V iJA-tA-IfJ(!E /AJM .s; Yf'tt.;6
G / vt;-1J /JeCEtJEIIIT 6 /f6G /hIIO LJ 1U/7l5D
IWJ Il..rry 7'P t:iJ/rHdM-MJ w/7J.It?tt r
l/1eiVltCry 7NE" FNHLJo c5'/I"tJut. /) /yfJT
/3E Su/&,7ec,r ~ /##47eIT/fAJcE ~.
(SEF: S'7/1-rcAtBl/T /1 TrA-M4f7j)
DATE OF DEATH
VALUE OF ASSET
tI
S; o/i'l,~
%OF
DECD'S
INTEREST
10070
EXCLUSION
IF APPLICABLE)
TAXABLE VALUE
I~o~
-t:)-
TOTAL (Also enter on line 7, Recapitulation) $ ,-J ~ .-"
(If more space IS needed, Insert additional sheets of the same size)
... 'c' !~:, . - ,
INVESAfMr.,IIIC.
. 4550 L^ffJADRiVE,STE 201
AfECHANClSOORG,PA 17055
'" <l-; .'.
<~~:'>'\ .>
....:.:.'..'
,'v'c.
" ... ~.;
:......,; ',.-"-':',
:18560~,,00t1891..o.
.. , ",I~f(~RY'IGRtiVER
i585S:HILl.SIDE LN
"MECHANICSBURG. PA 1705~2065 'I'W,",
'1.1 a 11"1111",11,1,11",,11.1111..,11,, ;til~ild~~II~~'h~11
, ,:;:"j'::':','>,-',
..;~, ;f-'
,-:_. <"
~":','.-("- " '.<'.
,,":, ,"', -~-' .' . '
REV-1511 EX+ (12-99)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF G- (( U. V E ~ I L IJ.M Y L.
FILE NUMBER
:2 /- IJ' - J'{)/
ITEM
NUMBER
A.
Debts of decedent must be reported on Schedule I.
DESCRIPTION
1.
FUNERAL EXPENSES:
CDc/(ufllJ6 FliAJE~~ HOJnE of p/u,SBURG-
PA-S7/J~ ~lIfl- IIpAl'pl&he/ttJ11
Sf. Ittu/~ Lutkra" Chl.trd1 cJ. :b i lid,,,,,,, - LUMc.hemt
13/1.$Sbtn SJwp pf iJ/l/sbuY'j - RblAJU' ~~
Add/hilA/T/ lJea~ fe.r-f,'(;'ca7~ f{J<I"~h (bl!.kl,'" i I=Un~ HlJnte
.2.
3.
4-
..r:
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s) /AI/I.III/I /Jt. ~p~ 713
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address 7/ S It; 0 AI( /UJ.
City D/t..lSSU/tfi,o State~Zip /71)1'1
2.
3.
4.
5.
6.
7.
r,
,.
10.
II.
Year(s) Commission Paid:
Attorney Fees Colt o.rlt.s E: ~J,/e..lc/s 1if
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
NONe
Claimant
Street Address
City
State _ Zip
Relationship of Claimant to Decedent
Probate Fees ud D rig i 11.1 i S:S l4e 4- ~hD,.r cut; fi'ca.t...s
Accountant's Fees l J'DI\t.S AceOlLnh', .f. 'blllsbu.tj I PA
Tax Return Preparer's Fees 'r p~ ,f e!6u' (J'I"I- /bfp, /lA- Vo / ItJII/, "II- 'II !6shirt.)
tf-r/ pert/Si1/ in el.t"'ber/~ LAM ~1I,.ntJ,1
IhIverf,'s,"!. i" earl/ak ..JeAh'ne/ ~"",IU"
Add; /lI.Il;,( ~N6d -Fee
F/;'", ~ 761' .-Z"lteJo,"fA"ee ~ ~4rn{(J,J,fJJ(.~)
,f.#,d'/h;IIAI cfh,l't ee"f,"6cQ;!-e$
(e.""ituul )
AMOUNT
~ /, 377. tJD
, 7S. ()o
~ I e 0.. 7lf
~ Sf, f.3
It" s'l. (')~
WAIVED
., If, too, tJf)
NON~
~
IfA~. ~o
'I- ;?, 7 (). 0/7
~
7S". 00
~/{)7..'9
t:>
'i$;IJO
~ 8: DO
TOTAL (Also enter on line 9, Recapitulation) $ J s: 3 V 9.2 C
(If more space is needed, insert additional sheets of the same size)
J(!H E/)# ~ / ~d',/
Fsr: ~F G/eUJl~ t/he/lY L.
Aq- /IIJ. 2/-P{,-/I?1
~
~2"Z. 7S
-. ...- .~. .-..-.....'...-.'" ---.---~-_._,."..._--,.,.-.-...._-,-,--_.-
fl
'17%.7S"
t-
~f2..~ CJ.
. 6:~.f4i;f~l'tfe,.b~~
f?~~-flie.l ,)6l!!t~_
~
/3.l'JO
IT4"At.S...p,c .t!#;he~e 11,,;.sI!r-?"~tE:/Jf4fN7..D,e..~~ PE.
.J ~ 57A- ~ f'PI SE"!'TfEM€?IT~~!,I/~t!,,4(E:P
I
.-1 7D StWEtJJl?Ei A:
.___._._~-._.g~) .. L/n~ .. ..1"-.-'. 1l~.4lt~!'::r__alKl!ll~~l~l! ~JiJg(6<<,_~in~Jtd. .
.._..__._.__......._...; ..-.kJ..... /~~!t~_.Z.e~. ... ....Z~l1..l~~b'p~-~. . .= .t...:::ti7__/1!~.r._n
. l n~~Jf,',,-~_I(~~.. ~r.j~4!lti~!:~~~.[..=n~_qm(!!1t._e..~-.
I
...ttf).!;~n/{'!.k..-.~~~-~..-...-.-. .. .
i
..-.L .'!.l_~~~_~~~~. 7r~-!~~.
,
....--l.fJ. .!.~/;~.(~~ ~J.k.~n_
__13.__~6'e;lIItb !A-rSlJ!l~.. fi..rhd~.f.~~6~' eJcI'1!I
" It , I
/'1. :
._. ---"1
......J~IH..'f'f;~t~..d .!II-'J!s....RL~~.. .
IS: AIAc.Honee-.!:~. .&~I!1/s.~I'~J1k.nf/4:~I:J. /k4c:h'o11 e Grs OJ1 .sale
~../JU'$f2!1~/f# ....(~et;./!!-ltJ.lJ!qt4.tjc.~-b.s~# ~)
I'. flllL HfJ?'." 6,il
11. t{, s. I~sf t)fhee - fl,~~t!:J tili.
If, /(lll,!(lrletJ hltl/lsf//.. ..tf~f1!17htsh
/'1. ~l'i51s~$.<<r. ~~~{It.I!,?~ ltA'!'!1~~.
:M. /}M,ie 1I1t6v'H~ e,l/uh~~ .7Y
~(. (Jf'f- f,.kf>.~/''rb,'/L
:J~.; fri- &ulJtf Ah$Jtacf ae,.v;c.es, l)eerl Ptep. ,f,r ~ae ~ ti&J Cosf
I
.11 (~~~!./'!:!!r~ M ~f, 6;;';'"
fIl
.s: 07.3. DO
.../."...............
'; I:.s. 40
--- ---_..,----,.-.~._"._-_..__._...__.--._._--"
"sea. co
!!
Is: DO
~
7S''I9
"S-~. Z~
, j'. ?z
'f'
;z'I.~2
'itJ]..o$'
~7' 1':2. 57
'-
'.J ~, '0..
'5'5.00
~f
.~
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can.
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
(A) OUR SERVICE:
Cremation.Option #15 .' . ~..' ~_ .'_._~__~_":_'__~_._~..~
-FuNERAL HOME SERVICE CHARGES . . .
SELECTED MERCHANDISE:
c
,.
.L.<I'".........:"J""~ .. ~... ! J V.l:/
(717)432-5312
September 1, 2006
Mrs. Wilma M. Spotts
71 Big Oak Rd.
DilIsburg, P A 17019-
The Funeral Service for Mr. Larry Lee Gruver
.. __. __n_._
Visitor Register . . . . . . . . . . . . . . . . . . . . . . .
Memorial Folders. . . . . . . . . . . . . . . . . . . . . .
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
THATYOUHAVESELECTED . . . . . . . . . . . . . .
Cash Advances
Death Certificates. . . . .
Death Notice Harrisburg
Coroner Authorization . . .
Organist Honorarium. . . .
TOTAL CASH ADVANCES AND SPECIAL CHARGES .
Total
Tota] Cost. . . . . . . . . . . . . . . . . . .
SUB-TOTAL
INITIAL PAYMENT I DISCOUNT I CREDITS
TOTAL AMOUNT DUE
laid balance over 0 days is subjected to a 0.50 % service charge per month - 6.0000 % per annum.
Please
$1430.00
51430.00
$40.00
$60.00
51530.00
$48.00
$199.00
$25.00
$75.00
5347.00
$1877.00
$1877.00
0.00
$1877.00
P......"AID
~"'!<:' '. .~
::' ~.~
DATf_'- ~ I Ol~ -= .
Mr. Larry Lee Gruver
Page 1
REV.1512 EX + (1.97)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
L.
FILE NUMBER
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATEOF GJ!.tlIIF,e/ L.A-ItY!-V
.2/- ~~ - 8()/
Include un reimbursed medical expenses.
ITEM
NUMBER
1.
DESCRIPTION
fJA-V-IJPF ~F F/RST /nf)RTGIf.6E- 7j) AfGJe5 t]Fe<s"It'1Y DAIt;
# I'e~ SlF'7'1ZtF4f8lT t5/1ElFT A- 7"7:;11tJN&l) ~ ..5t!#~.. /I- :
L ,'/It. S'D if
a.
G2NGteAL 'DEBT/LO/fN tAKeN oUT 4N.D GuAreANr~
By '7J../P/HAS R. S Po Trs 4-1/ IJ IfIIL.hI//- hi. S P"77!:; E>iGt:.-
UTltlx ~N /JEHAi./: 0/= ~ECGlJENT BEMkSG t!)~ HIS
/3,+1) t!REOlT ,eAnNti; €r~.. PAYAfEN7:S' ~ h/AJJe
:[)1/{E(!.Tt.y ~y LJEC!EDclVr 7b LEAI{)8'" /)1EIJtI&~ Iff
FE1>, cenlT t(N/~1(/ :
JJ At((;J(ST 29, r:!()()h
.&) SRI'7: I~ o2I!JOh (BAL.. IN FULl)
(,;,elF A-7?'A<!HE1J flE7lE7P: lI'AlF/IIAIJ/: ';;:'/<,h/ISSc,ey /fj()~
.5/~n> ~y LAMf L. 6/u(1"~, IJECEZJt9\I7; &>AJ .:TttL.Y ~
,;
,Jt}()S} &/JY ~F I)/l/~/;f//It. uA-AI ,l>()(!'UA1C'NT z)"'r.-r; :TilLY /9.
Ir " ;
~oS /htI/J 571UtjJetJ ,oA/./) t'AI SEP7: Z~~ 24~~,/ &I'J'DF
~
LPAN /le~tlJ1/T S7/fTE'/I(t!:Alr" ~/_ tMISE(!.a~ Ir /itU1H
1J1€//(eSlS /sr SltbkJ/h'6 /TGm5 ;I" A) ~ 2. ~ ~J/E
Ik ;;,.1-, J) / rl:7J15). (A-1.!JtJ CR.t>S$ R.~r;IneENCE 7iJ L.A-ST IAII/..t..
fP I. 7~/.s 7'NE L.t)/!N 7#E..t1E/1JI A$rEJe/eE1) ra).
AMOUNT
~
7~.1 'T/~ zS
,
3~.:s:99
,
if, 9,p~ {'7
~ s I. 2'1
~O.OD
POffIMtf1i. ~. 2l>()fD " J.iDMeeernita'(~,~ ~
I; 1'f7. '"
P'3Mut a,{50 J ~ ~~ iP HOA\e.~lt\i "'IS, f
~ I 7 23. 17
(set (!JJt~'stUllhM Jhui-)
:3.
'I.
S.
PP~L LLt;li+y loill
rnSH MC PhysiC: A.r1$
:Il1te.r:1l1 ntorfqa.ge
Se,rv,cer 0,," LoQ.R.
:r,,+e.-im Mort~D.3e.
:hc:., ~v'lcer." CoUI
(,.
TOTAL (Also enter on line 10, Recapitulation) $ 9 ~ ~'3. 1/'1
(If more space is needed, insert additional sheets of the same size)
I
. ,
5(!J{€D =r:. / ~nt;l. fJur 1-
ESt: DF ~ffiJ; f./ItlIif L.
7. tvt.sf Skrf EMS
r .::J:nkrl /fl.. /}u;rf~ ..~t1tenI~f. .. {)cI-.7/)Ob ~.
k. ~~;~. ~. 4>iU1
~I' It'!! E/J1U'f~;(7~/~;vJJ'
It ,t H
B LeNI. .:j1/ - oi, - fPI
~
1" /2tJ. 3$
t4~At/l1fS.
/1. Un; y. III ;JUJI/~~~4"...f~~y;~
1.2. ~ 11//(IiiJ1~g4Y~/~qMd
13, ~Aq,Ic/e-1i .. d.~.. . ..NrM!jj dl' O[fM1~ei![/D (J,flb,r med: (0;/... ~t.qJ.pJ: es
/4. Nesr ~H- ~ &'Plk - fUll'll.! ~e.S. . ~~~
,.
9..3 t. 3iJ
fllsf 3S'
~ 1. 'f~
~". 6~
1l', 7/. W
'/f!)O . ~[)
~Stf. 79
C'" ~
I Larry Gruver agree to pay Thomas R. Spotts and Wilma
M. SpottsJ15,644.80 in monthly payments 0[1325.94
That will come out of my checking account at Members
1 st. Starting September 1-2005 and ending on August 1 st,
2009. If anything should happen to me before full
Payment is made the balance shall be taken out of my
Estate to payoff the loan at Members 1 st.
~lst
MEMBERS I'
nnnllnf"'~
5000 Louise Drive. PO. Box 40
Mec:llamcsburg, PA 17055
MEMBERS 1 st
CLOSED-END ~SJIIt~ olon
9.95%
NVMIER
MAT AllY DATE
lEI FIXED
o VARNlE
ANNUAL PERCENTAGE
RATE: The COSI 01 your credlte. e .
yea~y rate. '
FINANCE CHARGE:
The dollar amountlhe credit will
cost you.
$ 2.82821
Amount Financed: The amount of
credit prOVIded to you or on your
behalf.
T olal 01 Peyments. The amounl
you will have paid afler you have
made ell payments as scheduled.
9.95 %
$ 12.816.39
$ 15.644.80
Varlablt R...: I' your toM h.. . v.n.bte rate as tndated 8boWt the Annual Percenl8ge Rate miy ll1aU1. d;;nc;the tMn of thiS ti-a....ii.ctton If vie (Ind';) change. The
c:redll union wit add . IMf'OIn or 10 t.... Ind'K ntue The r.. WIll chang- monthly on the fiRt dB)' of the month The rail wtlI never be higher thoWl the maxmum rII.e .1Iowed by
low. and K will nev.r Ilt 1e.1 IIIan. Nty "_.1 ,..._.... WIll........ _. _to 01 III. 10m. .mounl. FOI E....."... d yout IotIn wal fOl $5.000 0115% for 48
moRlhl and the Annu" Percentage R... tnCIeued by ~ att" one V",, 1M tarm of your 1000n would Meu. by two monlha
'Prtlorllld _. 11_. lho fallcMng app/ltllO YOU' Io8n
n Aut_aile Payment Dl.counted Rate: Bocault you hove agraad 10 make your required monIhIy poym.nll Uvough an aulomltlc de<lUCllOn flom you, Checklng/S.vlngl
.G:ounl. YDUI ANNUAL PERCENTAGE RATE ha _ d1lC11un1ed by .20% Tho ANNUAL PERCEI\ITAGE RATE d1ldoltd ebovt In the ANNUAl. PERCENT AGE RATE box II
the AulomallC P-", Otocounted RaI.. Ths note WIll mcre_ by 20%' you _ thelUlomallC pormenlllll'8ngement 01'81110 .....nten auffiaent fund. In your accounl to
......, the a_c payments. In Iucl\ a ..... the effect at the __ W1I be 10 exlend the lerm d your loan FOI example. ., your Aul0tn8tM: Payment D.scounled ROI. is 10%
on a $5.000.00 loan for ISO _hi and you _.. the 8UIOm8IIe payment e"lIIlG8menl, you< rlll8 wdl'ncr.... to 1020%, reoulunv In 1 add.,anaI poymanl.
Vartable Ra" p,.r.rNCI Loans. If yow kJan " . v...... ,. IOen and you qualify tar I pret...d ,.... your pteferred dllCOUf'lt II laun .. the tme you like out your lOin Thl.
.......1 pteferNd ANNUAL PERCENTAGE RATE will than vary ecc:ordtng to chMgIII m thl'ndu (I' dISClosed above). For IXampt.. If. vlnIIWe rate to.n', nl..1 ANNUAL
PERCENTAGE RATE II 12110 eI lhe ..... you Iak. IIuo 108n, youl ...... pref._ ANNUAL PERCENTAGE RATE WlII be N/AIIo Your .....1 prel....d ANNUAL PERCENTAGE
RATE Win hn v.., ~g to the Indell, _ dJldOMd In'" "'ll1IbIe Rat... pl'OYlllCll'l above
Plxed Rate Prol....d Loans. n your loen '" a _ rot. loan and you quallly for a prel."ed rate. YOU' ANNUAL PERCENTAGE RATE WIll be the pref_ ANNUAL
PERCENTAGE RATE dIsc_ _ lor ..lOng as your preferred llalul ......... .n allecl
Numlltr 01 p.ym.nll Amount 01 p.ym.nll ,,-.1 Frequency When P.ymanll Ar. Duo Property In.ij;:aiiCi:vou may obiain pr~-'
'as insurence from anyone you wani thet Is acceplable to
P.,.,ont 47 S325.94 Monthly. Beginning 09/01/2005 ~dc;r:.~~n~'l; ~Yt~art the ,nsurancelrom the
s:a:. $32542 Final Due. On 0810112009 $ N/A
Secu~ly: Mcwtng Oltlor loan. woIh the er....1 .....n I th. g_1 or _OIly Other
W111e1so UlCUI. Ihllioen You ere gl_e ,acunty ,.....AlSt In l be.ng purch...d [-;l(Oelerobe).
your__dtpooomlhecnodolunoon.and:, ..X._ SI.q~~:rURE.
~=:::.: t"1::5~~::'~ ~~':"0I::..r' WIll ~=n1r::=~=~:;....n::::~~=~f'::.~dOtJ ;II~~ FHa: ;O;:lIIng Insurance:
nol have 10 PI' . ,...ny, . "'" coM' doeurMnW 10' 'IIY' I mIonnlbon.bouI,.,..",.. , any '.&pIed "~nlll
.... .CMckMd a.. and JIIl'eIlIYfII.'" ........ Ina p.......
MAKE
12.81639 Amount Paid to others on your behalf (Deacnbe)
12,000.00 S3204-4 To IIm_iAa $
S.ve us To 1I....1lIa L.te $
S n $
S To sooo
S To A1lad_" $
SECURITY INFORMAll0N
YEAR I 0 NUMIlER
To
To
To
To F....
To AIotcI SOlWlnI
$
MODEL
TYPE
VAlUE
OTHER (Describe):
You Pledge Shal8a
and/or Deposits of
AMOUNT
S
ACCOUNT NUMBER
AMOUNT
S
ACCOUNT NUMBER
You agree \ht\ the Ie"'" '"'" condlllon.., "" dlRlosuno _ and the _ and ltCIInIy 811"-'_ on _ 2 ot IN. _I Ihalle""'y \0 1hI1_ It lhoro II mOla
than .... bOl'_, we agree lIIe' ..I tho cond...... at the IotIn and Iecunly aglHlllenl. governing Ihfl toen shell apply to boll JOllity and.....1Iy You .cknowledgelhel you h...
receIVed. copy oI1he lOan end lecuritY agleemlnta Bnd dlSdosure ....emen' Co-.ugnlr. U yOU ere IIgfW'lg as co..lagner, you acknowledge recetpt of ,he notICe lo co.SIgI1ef
on pog. 2
SIGNATURE
DATE
(SEAL) 7
DATE
(SEAL)
o "CO-SIGNER DATE
(SEAl)
x
o CO-MAKER
X
DATE
(SEAL)
o 'OTHER CMNeR 0 "CO-SIGNER DATE
(SEAL)
.nnelll.OWN!:Jf:""'r,..._loW"h.. ,..,:,.~ ..\_t"""'.,..... ........ ......IoIlf''''... .r...M'KI_................ fM...,.......unIfta.....C1HIIIII................... ,.,.........,. ....,.........
............ ~ __...................... ............., ~ ..Co..J... u.... .....""CNdll_..,....II..........,.,...,. .........,.,.., "'''' ~............... n.
...,...... _.. ....a.............. .....-.-.............,...
APPLlCAll0N FOR GROUP CREDIT INSURANCE
1=I~R..:::=-===:=.v'===.:.~c:,~=~~====:::rw:,~=~~~::-na:::u:=-::w.
..... be"'" _~ 1_ _"'Ioan. _...__a_ tranolllogollle lor """""'" AI'PUCANT CCMI'P15ANT
na. ........n. .....0_. t ..... Z. mu.' lie .....,.. to dltemint.y lOUr) ..gIIt."or lnlU'ancl. .YES HO . m
1 C~IO".I~ cowt8Otonly)WIIYOU ..........70on...lChldIHd"......,dlleolyourkan" 00 0 l!J
2 .=.-.::.:.-:."',:=~"'1r':=or":.:::::.:=:::.~:~~~":l:==- [!] 0 0 00
In .ddtdoII. r,<<;",... ex,'" S 2'.100 '.I"'OI~ 11ft_Ion...... 1M ............ ens. I. de1t1mtnt eltDlbdllJ. 0 FV1 0 FV1
3. ..=..~~~...IT,:=~~AU~=&...,.'*:"'~_or_ryWlYofl.....lllOk.. l!J l!J
==r~:=~=:w'...:=.~=~~.:::.=r.:'.=:.-.:.-:....:=.~=~=~~~~ ...ltIlpersml.nDt.....fDr.,~and
The...... Ill.. II my (aur) nuance'" blre..... GI "seJlrlllalan Att'I penon who Icnowtna'" .nd Mth Intent to defraud In, "'SUPMC' CClI'I1JNIny or _... pwwn f.... In .PIIIlc". for In......""
or .....menl or claim CCIftI:MnIntII;I')' m.......y .....lnfanniihm or cone.... lar 1M ~.. .-, iN.la...n.. '"'ona...... 1COnc:t:c.:'ac1 maIIrf.ltII.do conwnh. . .........Ient In....nc. lei
=:=~-::-.:.n::=.::.=.r:.r.:.~~~ -: ~.:...:.=:= =-="':'~':J= I~c:r;=''=::' -:.......ria ..-plta... wII '* tMI......kt canl... If... appIk:.M.
CReDIT INSURANCE APPLI!D POR:
: NOT! ONLY ONE APPUCANT MAY APPLY POR DtSABlUTY COVERAGE.
o Yea ~ No
~ Yes 0 No
IncllClll8 _ .pplocanl(s)
Single Credit Life
Joint C,edil Life
ill AJlIlI'cant 00 eo.Al>Pocrml
Total Premium ~ Yes 0 No
Credit Dlsabllty
Total Premium
S 320 44 Ind~ whloll .pt>locanl(s)
00 AppbcOnt 0 C...Appllcan.' $ 495.95
OATE
D","_ 1 rof"J
COPYRIGtIT lUIl7 U.",....d. Nuu.l~. me All ngtl. .....rvMl
~~~If,S~tJlJ'Ff.f=~fs)THE WORDS .CREDIT UNION" MEANS MEMBERS 1ST FEDERAL CREDIT UNION THE WORDS "YOU: "YOUR" AND "YOURS. MEAN THOSE
LOAN AGREEMENT SECURITY AGREEMENT
F,.?~:~rJ'~~~sC:~:1.:;:o:>Jr;t:~~e~I~~in~c;.~f~~~N~I:::~~, at
pursuanllo the disclosure Itatement on page 1 of Ihls document. You
understand that the finance Charge and tolal of peymen1s shown on page 1
01 this document are b8sed on \lie assumption thai aU inslellment payments
will be made on the aCheduled due dales. and . If you have quallfiild lor
prelerlBd rate that you conbnue 10 labl~ \he condlllons of thel ereferred
:~~"I~T:r:lrox 3:'1 ~:~~':'ar::,~~nl e time d ts due. you will pay
Allocation of Paymenta and AdditIOnal Paymenta: Payments and
credits Ihall be applied In the followillg order: any amounll past due: any
fees or Charges owing, including any Insurance premIUms; acx:rued intaresl
orllnance charges: outslandlng princlpal Payments made In addition 10
regularly aCheduled paymenls lhaD be applied In the same order.
Pretelftd Rate: If you qualllv lor a preferred r8\e as dladosed on page 1 of
thIS documenl or In a aepatl!(e preferlBd rata addendum, you undelSland
thai you must meet the ConditiOns dlscloled to you In order 10 quallfv for Iha
preflirred rale and mUll conbnue 10 meel those condlUons In oi'ller 10 keep
your preleiRii/ rale If you faU 10 meet thoae conddlOns, your rate WID
,ncreale. therebv extending the terml of your loan. You prornlS8 10 conllnue
making paymenfl and 10 meet aU obligallilnl under this Agreement eY8l1lf
you no Iilnger receive the preferred ra1e.
~~ 1:~~~~~~g~ =": 1a ~1lf,;f~0':~efu~u agree 10 pay a late charge
property Irwurence: "you obtaIn a loan secured by a molor vehicle or
olher langlble pr:aerly. you must obtain Insurance which prol8c1a the credit
~~~a:::' ~:r~~~:' J~ ~::'~~I :''I:~~~~t=epo~~st
prowle at leasl fire. Ihe~ combined adddJonal caverages and colllllOn
Insurance. II must cardaln a Loss Payable clause endorsement naming the
credll union as lien holder You may Obtain this Insurance tram any agent 01
your choice and dnct the all8nllo send the credit union a r.npy of Ih8
policy.
Debtor Rnponalblllty: You promlS8to notify credit union of a!lY Change In
~:r~,::e~:l:ses r':a:.,m,r>~er~\'~~1 ~~i~~:I~O.:"8'J.~ ~ ~:~~
your obligation accordil)fllo the rerms of ~ credltexlenllOn. You prorrnse
10 Inform credit union of any new ..format.on which rBlaw 10 your ability to
repay yolK obllgalion. You prollllle nol to submit false or ..aecurata
intormabon or WIllfully canceallnformallon legardlng your CIlldllworlhlnass.
credit stendlng. or credit capadly.
Oefaull: You shall be considered '" default I' any of Ihe following occur: 1)
If you break any pro,",se made under this Loan Agreement or under the
StiCUli1y Agreement: or (2) I' you do not use the money the CIlldlt union
loaned you for the pUlllC!le Ilaled .. your app~callon; or (3) It the credit
unIOn should. In good faith. beluNe ht prolpect of payment. oerIormance
orreallzallon of the collatarel. il any. Is Impaored: or (4) II you die. or (5) If
you file a pellbon in benkruP\CY. inlolvency, or recelVlitshlll or are put
involunlamy .nto such proc8edongl. or (61 If lhe collateral. It any. given as
secunlr. for 1I1Is accourd II Ioat. aamaged or destroyed, at if .1 IS livied
agelns . allached or garnIShed, or (71lf you do nol p"y on time any of your
other or future debts 10 the CIlldiI uiion If you defaUlt. the credit union may.
al the credit union', op\IOn and without prior nobce. declare this loan
Immediately due end pavable. and you mUltlmmedlal~ !!ay to the credit
union at thai time the lofal unpaid balance. as we. al Ihil Finance Charge
10 date. any lata ch8llles and costs 01 ""hcllOn permlll8d under law.
including reasonable aUo"18Y'S feel, \hat the credit Ul1lOn may Incur. up 10
20% of the unpaid pnllClpeland Interest Cosls of collecllOll lriclude. but ere
~~~~~~~, ~::.'"~;str:~~~~::;"r",,~~l:~~y's Ie.. for
any aellon taken by an attorney In order to coIIe:ihls loan or PlflselV8 or
prOtacl \he credit union's IIghlli and remedies. Including. wdhoiJlllmitabon.
pre-suM demands for p!!ymenl pre-sUll mediation or setuement
nsgotlalions. Invel\Jgaticjn anil assessmenl 01 the credit ulllon.' nghls.
palllapallon In bankruptcy cases. melt.... and proceedlnp,1 (inckiiling.
:=,~m=, ~~J:~~~ .:='~-::uI's':.rsul~~= :::~ti~:.~nl..
objecllons Ihat rel!:ta In any way 10 Il\e cred':P union's coIaleral or nghtlo
rcl,g:s~~:==s~I~";m~p~r.~:~ccle~~~ :~~o~::r'Y~:'~:~
the canlr8cl rata
Stalulol)' L1an: If you ere in default. federallew gives the credll union the
r1ghllo abDIy the balance oleharea and/or dividends In your account(sl al
tM lime 01 delaUltlo satialv lhil loan. Once you are In aafaull. the cnidlt
union may eXerclle thll rigl1l without further nobce to you.
~I~ ~~~~ri3:~~t~'::"'~h~ 1~:1~ ::e':ang any ollhe cred,l
l".gul8r Paymenta: The credd union may' acceptlale payments or pallIal
paymenls, even thouah marked "paymenlln fUll, wHhout 10.lng any of lhe
credll Union Ilghlli unCIer this agreement.
~::rv~~~~~: ~i~';re,t=:."b~~: ~~itn::;:~' ~ ;3~e.. lu
BIther or 60th of you. Tha credit union does not have 10 nOblY you thai thl.
agreemenl has nol been paid The credit union may extend (he terms of
paymenl and relea.e any security without notllylng or releallll9 you "om
rasponsiblllty on this agreement. .
~R'S_
THOMAS R SPOTTS
~==,~:~I~ s,::.'::a:~:,-:,a.~ ~~:~r:'':iI''':':~r:::~~::'o
_ul~ the c_ union mey allllly _0 Ohe"'l .lId doposllllo tho paY_Ill
oIelloumo duo..the _ 01 dtlault, Includlng ~ 01 collocllOn ond
roooonoblo _may'o _. thot tho crodlt union mey Incur, "II to 20% 01 the
::~..r.:r.~;: ~::':I':; ~~:..:~a:::~':.":: ~~II~~:~:'.!r~~:"~1
Retirement Account.. or -Keogh Plan. po
L<l^N NUMII!R
118994
OA TE Of LOAN
07/19/2005
ACCOl.NT NUMaER
19723~O 1
~:I::I~r:~.r.~~~~O~e:~'~:~ :\:::I?:I~r: ~n~~u'~ty.,",a:-,.~~~u
grant to the credit union a ..curftY In....... In tM Crqplrtv deacrlbed on
PIgI 1 01 thle dOCU~L Th, aecu:l ~nt.".t Inc udal an Inc,.....,
r:.:r~~i:: r.d .~~":r:':~':n~~ l.':ft~~ll=::~,:mth:ny
HCurod ptOparty.
=~i:aolJ~=~::JB:':g 1~~~t.~nr:~~r.':~u~'aI'f:~:~:~.ny
~:~=r:::.':'=::C-JlIU.r:~~":..::.'.':: r=.. How:~,rropeny
Borrowllr'. principal Naldencl tunl... the p'cu:;' ...cCc'n naUe.. .r.
1::~I~:lh~=~ rwquINm..... .re sa .ned), or.... non-purchal'
You wlUnOC chq. the IOcIIIOn 01. ,d ortrWllfer theCGUalI,..1 UN", you heve
the credit unton', pnat wnlten consent
~t~D=~l:~h~-:r un:: ~h:x:::wtal'::':~-:t :::~:'Its
;J::' -- 01 th. coII8tsrot who ho. .ognod tho agroom.nllllho .ndICOI.I
You ....I!!IY .. ....., e.uumonl., and l.n. _.t or 011_ to IhB plOtlOflY
de....b.d ind further agrooto koop 110 properlY Il g_ conddl... hau.... Il a
Jult8ble Ihelter You~.. to execute '.,ancrtg IlIrementlllnd aecunty
~':v::'\1.,'7" ":n~ =m~l 1.11110'1" request and will dehand the property
You will mama.., .....utlf"fCe 10 cover Iny whu:te or other ~y in which the
ctadlt unIOn hel . HQlnw rUBIes. Thlllnsurance win be In . fotm and In
amount "''''1Clofy 10 Ih'erod~ unoon Youw~ lUPplylho cr_ IlIlI.. W11h proof
of luch NUT.nee lllll .u IUfI\I CNMd to credit unM;t\ .,d aecured ~hl'
~,lq~'3r:.' .J:.r.'\'='::== ~~~:'."=l\ll':uchm~r.~
.urn. owed lllIa coli WIG ....r II1lIIrell et the aIf1lroC1 rato unlll paid You lunher
UI!QR to the credit untOI1 lie nght to racetve the proceeds of Iny Inaurlnce on
ludi ~Y. Md duect any If\IUIW Ia PWf. those ~edl dlffict1r to crldt1
t:o~..u:r~ ~tufc:,~= ~~t:.~;~'::=' ~~V:"e:c.I~
the cradn unoon
~~ ==:;z.:~r:~t,:~J~~~ C':q::.uraea":r='1Ce Cent.r
~~.c:=~=Ir:y~:~ty~-:I~:~o:or=-:~=::,d~e
crodN UN"
== ~:~I:f:e~~ :l~~.:rU:.I~::=mec:S~Ulred. au
m=" 10 e"1gn 10 crolll ...... _Ill.. (10) lay. _laver ed~IIlDn.I'OCUrlry
Jon CrefM unIOn 'eell . necesllry to protect the credit unIOn aganst poS11bI1
If I d.'.... It defined 11'I the LowI Agreemenl .houId occur, the credll unton hi'
::::~~::=C:'=~ ::'=~:S=rt-:~::t~-::!:11Wtu1
~~=:~;l:~':k~hI~=~,:= :~,~.n:wm:~t~~Ir"
unIOn haI the hahl to ren ~ It coI....ral unuaable and
I11lIl' IlIpoIo oIlhe cdl= . Whore tho Brolll kopl ,,\h.
::="lI.:ec~~'3,:. ~ eu.:.= :t. ~lel:' bmo BIll
Plec:o oIlhtl:ll':_ ....poa IClI1 YI PrIor 10 '" If dl.PGllbOn "
the c;rHlt un.., .... 01 otherwIH Of the coli..... the c:redIl unIOn me)'
:.'=:'~~,=ner:.lo::: ~ :lolll~~:"oIcIt'hY.::"~
~... IfUIY silo co..ct........ t.n and legal oponoo.. ponnlllOCl
_ClIble low. WlC\ll'r.d II 00 dllpo'~1Dn or \h. property Unlo..
i18....u. you ,"18Y IIeOP pooooa..... 01 . property (001-.011 deocnbod enl
UI' It" 80YlIIWtut mlll\Mr 0GnIII1en1 :Ih... 8SJr..ment or with the lnIUI'enGe
~=I =.......:in=.u'':''r:-" ~'==u:::\:-O":.t:n~"Y:
Cod. BIll IlIher .ooIlC1bla Iew." :J'r..lho ere"'t u....n may u.o 1lI.1. ~gh\l
to OnlCllC. paymeill of you delaU. In 1hot avonlol':'o wII ot tII. cr... 1011O1l.
=~,':.7=:'~=~<':!':''='~ 11th. ~:'~~~IlJ:-~.
we,.. 111. iIoIault. ~ ... nOl COIlabbn. _or"" ony _r aubHquonl d.'BUIt.
== =~~I~:X rll:".,t:d ~AtI:=;::'-:c:,::,or:,"lt.
NCUnty m.... which Iftll .graarnent creates
~~~I=ar:ac::.=:~~o:.=~~:"or:~g;r~~~~:.re
agro.ment
10 ='~~:8~nt not only binda you, but your ..lCUlora. admlftlltralorl,
3.
9.
SIOO 2IllIl
NOTICE TO CO-8IGNER
~~~ Ir~':.~~e::''':nll' 1~~r~':'::"~\"lod::e1~\'i\ts c:'.::~:::r..tli~:.e you do. If the borrower doesn1 pay Ihe debl, you win have 10. Be aure you can afford 10
~::,~::;:r.y have 10 pay up 10 Ihe lullamourd of the debllfthe bonowerdoel not pay. You may also have to pay lale fees or collecllon costs. whICh mcrease thiS
The credllor can colleCI this debt from J:ou without firsl trying 10 collacllrom Ihe borrower. The creditor can use the same collecllon method. .~a,"st you thai
~~. 'f'I.':: ~gl~'~ '::'~~~=fia~ Irw::'''::i ~~'IP:~:'~~l~bragel. etc. If lhls debtts ever In defaUlt thaI fact may become a part 0 your Cladit
F.437691102
APPROS_./no.22'.'078
Page 2 of 2
=
-
-
!!I!!!!!!!!!!!
LOAN ACCOUNTS
0i-UNSECURED
----~,,'
Transaction Desaiption
Balance Forward
.. ;,\.<-:-:'
_'__Paymerrts'---'__'__._.___:.::~~."c: :"-~'-"_.: ' ..-
Payments
Payments by Check
UNSECURED Closed
H~7his is the final slatementpresen/inginformationon,thisproduct~"
~H Please reIai1 UJistnalstatement fortaxfffllJCllfi1gpurposes ,~..,~
Amount
Interest
Fees PmciPal ",c;~lance
"""',,'.",,) ',', ., 'i.. >' ..",'",10.271.27
o . orr-- ~-'-'22tt:'94;'10 , 029 ~-33
0.00 181.04- 9,848.29
0.00 9,848.29- 0.00
Date
Jun 25
'-jul 07
Aug 29
Sep 19
· ~:' --" . .:.:.::.:": ::-325:94~:::'-';"~g2f:i:)(f
.32S-Q4 144.90
9,,~ 56.38
YTD SUMMARIES
TOTAL DIVIDENDS PAID
00 REGUlAR SAVINGS
05 MCfSlEYMANAGEMENT
406 MCNTHCERT
49 9 MON'FH NO PENALTY, CERT
Total Year' To Date, Dividends Paid.
NOTE: Total includes closed shares
REV-15~3 EX+ (9-~O.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATEOF ''It.UVQ., LA-I2Jty L.
:l/-t:J~ - 40/
FILE NUMBER
RELATIONSHIP TO DECEDENT
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s)
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1.
~.
SttYA-N G~uVfll.
ItS ~ ICHtAIlf) tA-IIE AP-'; I/)S'
CAh1! HILl/I'A 17o/t
lAJ/tlYJA- 5P()-rTS"" 7J{IJ/IIA6 Sf7D 77:S,HB<'
HllSI!JA-#j)
7/ ISJ r; OA.K ;eA.
V 1l.l.SS t{I(.G, PA 17p/1
3. IV !f,fe y L 0 tt.AN(; iF
p~ t!Jox . I ~g
/v1.()SSeyNElI-D, FL. 32'13C/-
If. /l)1t."AIH If. G/l.J{YEI?
1S2'1 SHIell:"'" .tfrF.
e~IUISl.€J JJA /7t?/3
St;#
S '.57t7i rJ-
8bTN6-~-/IV-ulW
~'S7~
/b/2.()'J}(~
AMOUNT OR SHARE
OF ESTATE
I T~m.r /J) .t./f.F: hI='
4J/U-. SGE ITEAlIZ. DN
S(!N". E.
IrE/I1.S IAI 2.S,c. {) bF
/,Jill.. SEE" IT~hlIZ~ o,.}
SCHIiiD. E.
ITt:Fn,S IN .1. D ~F WILL
SEE- ITJENlIZ. ~N JU{IJA
E.
ITGm.s IA) :{ tr OF /JJ Iu.
SEE /7lii'Af/Z. DN SeHGl)
IF.
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART 11- 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)
,I
ot:::---- - _-.,.
LAST WILL AND TEST AMENT OF LARRY L. GRUVER
!, LARRY L. GRUVER, single man, currently of Hampden Township, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this
my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time
heretofore made.
1.
I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can
conveniently be done. ! specifically include within this direction the balance I owe on my loan from my sister,
WILMA SPOTIS and my brother-in-law THOMAS SPOTIS.
2.
I give, devise, and bequeath the following specific items to the following specific beneficiaries:
A. to my son, BRYAN GRUVER: all of my electronics and stereo equipment, including
but not limited to: computers, computer software, televisions, DVDs, VCRs, and the
like.
B. to my sister, WILMA SPOTIS: my Shirley Temple glass.
C. to my sister, WILMA SPOTTS and my brother-in-law THOMAS SPOTTS, by the
entireties: lawn mowers and other lawn care equipment.
D. to my three (3) sisters, WILMA SPOTTS, HELEN RUNK, and NANCY
L'ORANGE: my knick-knacks, including my angels, Christmas ornaments, pictures and
the like to be divided amongst them as reasonably may be.
E. to my brother, WILLIAM R. GRUVER: all of my hand and power tools.
F. to my son, BRYAN GRUVER: any motor vehicle which I may own at the time of
death. In the event there is any outstanding loan balance on such vehicle, my said son
shall be responsible for paying off the balance. However, in the event he is not disposed
to do so, he may disclaim this bequest and it shall become part of the general residue of
my estate.
I understand that by making these specific gifts they are given priority in the distribution of my estate
in that any taxes, fees, commissions, and the like which are typically assessed against their value is to be paid
from the residue of my estate.
In the event any of my specific beneficiaries has predeceased me, then his or her gift shall lapse and
become part of the residue of my estate.
3.
All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and
wheresoever situate, I give, devise and bequeath to my son, DRY AN GRUVER, ver slimes.
In the event 'that I am not survived by any issue, then I direct that my estate be divided and
di,"'b,,,,, ,moo, my bmdi", on' "'~m, p" "i'PJ~~~
"
.
4.
I nominate, constitute and appoint my sister, WILMA M. SPOTTS, to be the Executrix of this my
Last Will and Testament. In the event that she is unable or unwilling to act as Executrix, I appoint my
brother, WILLIAM R. GRUVER, to be the Executor in her place and stead. In the event that he is unable
or unwilling to act as Executor, I appoint my niece, LYNDA S. BRITT, to be the Executrix in his place and
stead. I further direct that they shall not be required to file bond or other security in the Office of the Register
of Wills for the purpose of administering my Estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this J}./t day of
M-. , A.D. 2005.
,
~(SEAL)
LA . GRUVER
Signed, sealed, published and declared by the above-named LARRY L. GRUVER, as and for his
Last Will and Testament, in the presence of us, who at him request and in his presence, and in the presence of
each other, have hereunto subscribed our names as witnesses.
~ cr~ LiL
~,*c'