HomeMy WebLinkAbout09-24-07 (3)
REV-1500 ~ + (8-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 1712~1
REV -1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENrS NAME (LAST, FIRST, AND MIDDLE INITIAL)
GLUNT
DATE OF DEATH (MM-DD-Year)
BLANCHE
DATE OF BIRTH (MM-DD-Year)
M.
01/24/2007 03/01/1917
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
00 1. Original Return
o 4. Limned Estate
00 6. Decedent Died Testate (Allach copy of Will)
o 9. Litigation Proceeds Received
D 2. Supplemental Return
o 4a. Future Interest Compromise (dale of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Allach copy of Trust)
o 10. Spousal Poverty Credn (dalIIof death between 12-31-91 aod 1-1.95)
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. ~ BE..COULE1ED;AU.COJIRESPONDSNcI:AND CONF ,,'fM; . .
COMPLETE MAILING ADDRESS
60 WEST POMFRET STREET
0.00 X _(15) 0.00
0.00 X _(16) 0.00
33,084.15 X .12 (17) 3,970.10
0.00 X .15 (18) 0.00
(19) 3,970.10
NAME
STEPHEN L. BLOOM
FIRM NAME (If Applicable)
IRWIN & McKNIGHT
TELEPHONE NUMBER
717 249-2353
CARLISLE
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Depostt5 & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage LiabUities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(9)
(10)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under See. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
OFFICIAL USE ONt Y
FILE NUMBER
2 1 -07 0 0 9 9
'"'COUNTYCOoE -'fEAR- - - 'NiiiiER- -
SOCIAL SECURITY NUMBER
1 99- 0 5 - 9 8 5 3
THIS RETURN MUST BE FIlED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Retum (dalIIofdeathpriortD 12-13-82)
o 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under See. 9113(A) (Allach Sch 0)
PA 17013
OFFICIAL USE ONLY
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43.142.41
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100,978.74
9,783.05
275.21
(11)
(12)
(13)
10,058.26
90.920.48
57,836.33
(14)
33,084.15
20.0
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STREET ADDRESS
SARAH TODD MEMORIAL HOME .
1000 WEST SOUTH STREET
CITY I STATE I ZIP
CARLISLE PA 17013
Tax Payments and Credits:
1. Tax Due (page 1 Une 19)
2. CreditsJPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
3,970.10
Total Credits (A + B + C)
(2)
0.00
3. InteresUPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty ( D + E) (3)
4. If Line 2 is greater than Line 1 + Une 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Une 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
0.00
3,970.10
3,970.10
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 00
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? ................. r- .J(l
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 00 [&]
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penaties of perjury, I decIa'e that I have examined this return, includi~ accompanying schedules and slalements, and to the best of rny knowledge and belief, ij is true, correct and complete.
Declaration of preparer other thlll the personal representative is based on a1llnformalion of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBL~ FOR FILING RETURN DATE
~M~J ~-f td)//.L/___-' ) f-/9 --tJ 7
ADDRESS 1553 SPRING ROAD
CARLlSL PA 17013
SIGNATURE OF P PA PRESENTATIVE DATE
AD
PA 17013
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. ~9116 (a) (1.1) (i)).
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)].
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
L\ The tax rate imposed on the net value of transfers from a deceased child twenty-<>ne years of age or younger at death to or for the use of a natural parent, an adoptive parent,
[;:;-t or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)].
~ The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)J
:2. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)). A sibling is defined, under Section 9107
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1508 EX + (6-98)
*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
GLUNT
FILE NUMBER
BLANCHE M. 21 07
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
0099
ITEM
NUMBER
1.
2.
3.
DESCRIPTION
M&T BANK - CHECKING ACCOUNT #710520
M&T BANK - SAVINGS ACCOUNT #015004198225954
PNC BANK - CHECKING ACCOUNT #5140422769
VALUE AT DATE
OF DEATH
2,561.80
15,802.87
39,471.66
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
57 836.33
REV-15~O EX + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER.VIVOS TRANSFERS &
MISC. NON.PROBA TE PROPERTY
ESTATE OF
GLUNT
BLANCHE
M.
FILE NUMBER
21 07
0099
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY
ITEM INClUDE THE NAME OF THE TRANSFEREE. THEIR RElATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER ATTACH A COP'( OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPlICABLE) VALUE
1. PNC INSURANCE SERVICES 13,679.73 100. 13,679.73
(ALLSTATE LIFE INSURANCE COMPANY)
ANNUITY CONTRACT #GA2771 04
BENEFICIARIES: HELEN DIVENS, CATHERINE MORGAN
AND EUGENE KRUGH
2. PNC INSURANCE SERVICES 29,462.68 100. 29,462.68
(ALLSTATE LIFE INSURANCE COMPANY)
BENEFICIARY: HELEN DIVENS
.
TOTAL (Also enter on line 7 Recapitulation) $ 43142.41
(If more space is needed, insert additional sheets of the same size)
REV-15.11 EX + (12-99)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
GLUNT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
BLANCHE
M.
21
07
0099
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. HOFFMAN-ROTH FUNERAL HOME 651.02
2. LINDA HAZLETT - FUNERAL LUNCHEON 126.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) HELEN DIVENS 3,000.00
Social Security Number(s)/EIN Number of Personal Representative(s)
StreelAddress 1553 SPRING ROAD
City CARLISLE State P A Zip 17013
Year{s) Commission Paid:
2. Attorney Fees IRWIN & McKNIGHT 5,000.00
~ Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees REGISTER OF WILLS 329.00
5. Accountanfs Fees ABRAM BERT - TAX FILING 50.00
Et Tax Return Prepare(s Fees PATRICIA A. ROSENDALE, CPA 350.00
7. REGISTER OF WILLS - FILING FEE 30.00
8. NOTARY FEES 35.00
9. CUMBERLAND LAW JOURNAL - ESTATE NOTICE 75.00
10. THE SENTINEL - ESTATE NOTICE 137.03
TOTAL (Also enter on line 9, Recapitulation) $ 9 783.05
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (6-98)
.
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
GLUNT
BLANCHE
M.
Include un reimbursed medical expenses.
FILE NUMBER
21 07
0099
ITEM
NUMBER DESCRIPTION
1. PHARMERICA - RX
VALUE AT DATE
OF DEATH
151.97
2. SPRING ROAD FAMILY PRACTICE - MEDICAL
67.65
3. CARLISLE BOROUGH TAX ACCOUNT - TAXES
4.90
4. SARAH TODD NURSING HOME - NURSING
50.69
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
275.21
"'''''~.(..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
GLUNT
SCHEDULE J
BENEFICIARIES
RI
M
FILE NUMBER
?1 07
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
NUMBER
1.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS pndude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1.
HELEN DIVENS
1553 SPRING ROAD
CARLISLE, PA 17013
CATHERINE MORGAN
Sibling
2.
Sibling
3.
ORBISONIA, PA
EUGENE KRUGH
Sibling
HAGERSTOWN, MD
0099
AMOUNT OR SHARE
OF ESTATE
33,084.15
PNCINSURANCE
SERVICES - ANNUITY
PNCINSURANCE
SERVICES - ANNUITY
PNCINSURANCE
SERVICES - ANNUITY
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
n. 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. GRACE UNITED METHODIST CHURCH
45 S. WEST STREET
CARLISLE, PA 17013
2. PLEASANT HILL CHURCH
23112 CROGHAN PIKE
SHADE GAP, PA 17255
3. AMERICAN RED CROSS
95 ALEXANDER SPRING ROAD #3
CARLISLE, PA 17013
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
(If more space is needed, insert additional sheets of the same size)
57,836.33
$
57 836.33
Continuation of REV.1500 Inheritance Tax Return Resident Decedent
Page 1
21 07 0099
File Number
GLUNT
Decedent's Name
BLANCHE
M.
Schedule J . Beneficiaries. 2B
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
4. THE SALVATION ARMY
20 EAST POMFRET STREET
CARLISLE, PA 17013
5. CUMBERLAND GOODWILL FIRE CO.
102 WEST RIDGE STREET
CARLISLE, PA 17013
SUBTOTAL SCHEDULE J.2B
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LAST WILL AND TESTAMENT
I, BLANCHE M. GLUNT, of the Borough of Carlisle, Cumberland County, Pennsylvania,
being of sound and disposing mind and memory, do hereby make, publish and declare this to be my
Last Will and Testament, hereby revoking any and all former Wills or Codicils by me made.
1.
I direct that all my just debts, funeral expenses, testamentary expenses and all inheritance
taxes (whether such taxes may be payable by my estate or by any recipient of any property) shall be
paid from my residuary estate as soon as practicable after my decease and as part of the
administration of my estate. My Executor shall have no duty or obligation to obtain reimbursement
for any such tax so paid, even though on proceeds of insurance or other property not passing under
this Will.
2.
If my spouse shall survive me by thirty (30) days, then I give, devise and bequeath all of my
estate, both real and personal property, unto my husband, GUY D. GLUNT, absolutely.
3.
In the event my said husband, GUY D. GLUNT, shall predecease or fail to survive me by
more than thirty (30) days, then I give, devise and bequeath all of my estate, both real and personal
property, in the following manner:
Seven-twelfths (7/12) thereof unto GRACE UNITED METHODIST CHURCH, Carlisle,
Pennsylvania;
One-twelfth (1/12) thereof unto PLEASANT HILL CHURCH (Huntingdon County), one-half
of which is to be used for upkeep of the cemetery and the remainder of which is to be used for
general church purposes;
One-twelfth (1112) thereof unto AMERICAN RED CROSS, Carlisle, Pennsylvania;
One-twelfth (1/12) thereof unto THE SALVATION ARMY, Carlisle, Pennsylvania;
One-twelfth (1112) thereof unto CARLISLE HOSPITAL, Carlisle, Pennsylvania; and
One-twelfth (l/12) thereof unto CUMBERLAND GOODWILL FIRE COMPANY, Carlisle,
Pennsylvania.
B,.:HJ . iJ.
B.M.G.
Page 1 of 3 Pages
- ,
4.
I nominate, constitute and appoint my said husband, GUY D. GLUNT, as Executor of my
estate. In the event he shall be unable or unwilling to serve in such capacity, then I appoint
FINANCIAL TRUST SERVICES COMPANY, Carlisle, Pennsylvania, to act in such capacity.
5.
I direct that my personal representative shall not be required to file a bond to secure the
faithful performance of his duties in any jurisdiction.
6.
I authorize and empower my personal representative, in his sole and absolute discretion, to
purchase or otherwise acquire and retain any investments of which I die seized or any real or
personal property of any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose of or
grant options in regard to any or all property of any kind forming a part of my estate for such terms
and such prices as he may deem advisable; to borrow money for any purposes connected with the
protection and preservation of my estate; to mortgage or pledge any real or personal property forming
a part of my estate or to join in or secure the partition of same; to compromise any claims or
demands of my estate against others or of others against my estate; to make distribution in kind and
to cause any share to be composed of cash, property or undivided fractional shares in property
different in kind from any other share; to employ agents, attorneys and proxies and to delegate to
them such power as my personal representative considers desirable and to pay reasonable
compensation for such services as may be rendered by such agents, attorneys and proxies; and to
execute and deliver such instruments as may be necessary to carry out any of these powers. In
. addition, I direct that my personal representative shall have the power to conduct an inventory of any
safe deposit box necessary to the administration of my estate.
IN WITNESS WHEREOF I have hereunto set my hand and seal this ~~.u... day of
, 1997.
~~
~ /A v.J.f- '14~ ittJ-d ((SEAL)
Blanche M. Glunt
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testatrix, as and
for her Last Will and Testament, in the presence of us, who at her request, have hereunto subscribed
our names as witnesses thereto, in the presence of the said Testatrix and of each other.
_~J';.. ~~~. ~tc;::,
Page 2 of 3 Pages
_.
.. .
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COMMONWEALTH OF PENNSYLVANIA )
: SSe
COUNTY OF CUMBERLAND )
I, Blanche M. Glunt, Testatrix, whose name is signed to the attached or foregoing instrument,
having been du1y qualified according to law, do hereby acknowledge that I signed and executed the
instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary
act for the purposes therein expressed.
J ~~~.~~;i-
Bfanche M. Glunt
~~.sworn or ~ed to and acknowledged before me by Blanche M. Glunt, the Testatrix, this
day of ~ ' 1997.
~~~""~ ~~A)
Notary Public
COMMONWEAL TH OF PENNSYLVANIA
. Notarial Seal
I' Corrine L. Myers. Notary Public
, Carlisle Bora, Cumberland County
',1y Commission Expires May Zl. 1999
)
: SSe
)
We, st~.ph~ L. "B/ Ol'l-Y\ lI.-A..~ ~t:lrel~ y. C{)~I' rlJ'W
the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified
according to law, do depose and say that we were present and saw Blanche M. Glunt, the Testatrix,
sign and execute the instrument as her Last Will; that the Testatrix signed willingly and that the
Testatrix executed it as her free and voluntary act for the purposes therein expressed; that each of
us, in the hearing and sight of the Testatrix, signed the Will as witnesses; and that to the best of our
knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no
constraint or undue influence.
COUNTY OF CUMBERLAND
---/~e
-Address ~';4;:-~~/~
~
Sworn or affirmed to and subscribed before me this ~(p day of ~ ' 1997.
~.~
Notary Public
\:- Notarial Seal
Corrine L. Myers. Notary Public
Carlisle Boro, Cumberland County
! My Commission Expires May 27.1999 !
, ..1
Page 3 of 3 Pages
~
@1
(9)
~
CODICIL
I, BLANCHE M. GLUNT, of the Borough of Carlisle, Cumberland County,
Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and
declare this to be a Codicil to my Last Will and Testament dated June 26, 1997.
1.
1 hereby delete the existing paragraphs 2. and 3. of my aforesaid Will and replace same
with a new paragraph as follows: "I give, devise and bequeath all of my estate, both real and
personal property, in the following manner:
Six-tenths (6/10) thereof unto GRACE UNITED METHODIST CHURCH, Carlisle,
Pennsylvania;
One-tenth (1/10) thereof unto PLEASANT HILL CHURCH (Huntingdon County), one-
half of which is to be used for upkeep of the cemetery and the remainder of which is to be used
for general church purposes;
One-tenth (1/10) thereof unto AMERICAN RED CROSS, Carlisle, Pennsylvania;
One-tenth (1/10) thereof unto THE SALVATION ARMY, Carlisle, Pennsylvania;
One-tenth (1/10) thereof unto CUMBERLAND GOODWILL FIRE COMPANY,
Carlisle, Pennsylvania.
2.
I hereby delete the existing paragraph 4. of my aforesaid Will and replace same with a
new paragraph as follows: "I nominate, constitute and appoint my sister, HELEN F. DIVENS,
as Executrix of my estate. In the event my said sister shall predecease me or be otherwise unable
or unwilling to so serve, then 1 nominate, constitute and appoint MANUFACTURERS AND
TRADERS TRUST COMPANY as Executor of my estate."
3.
In all other respects, I hereby ratify and affirm my aforesaid Will dated June 26, 1997.
2001.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 11th day of October,
.t?fb.AA ce )7) ~~AL)
Blanche M. Glunt
Page 1 of 3 Pages
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testatrix, as
and for a Codicil to her Will dated June 26, 1997, in the presence of us, who at her request, have
hereunto subscribed our names as witnesses thereto, in the presence of the said Testatrix and of
each other.
-~~
o(~ i2~~
I
Page 2 of 3 Pages
COMMONWEALTHOFPENNSYLVANIA )
: SS.
COUNTY OF CUMBERLAND )
I, BLANCHE M. GLUNT, Testatrix, whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that I signed
and executed the instrument as a Codicil to my Will dated June 26, 1997; that I signed it
willingly; and that I signed it as my free and voluntary act for th~ purposes there~ fressed.
~d:q( tAt t n1 ~
B che M. Glunt
Sworn or affirmed to and acknowledged before me by BLANCHE M. GLUNT, the
Testatrix, this 11 th day of October, 2001.
~7-:~~
Notary Public
~
COUNTY OF CUMBERLAND
)
: SS.
)
Notarial Seal
Marika T. ChronIster, Notary PubIlc
u.~1Wp..~ldCounty
"'1 1 Expires Mar. 14, 2005
Marmer, PennsylvariaAssociallondNolaries
COMMONWEALTH OF PENNSYLVANIA
We, 0\--f~U\ l. l~oom and Loft' A. SLLUiv~
the witnesses whose names are signed to the attached or foregoing instrument, being duly
qualified according to law, do depose and say that we were present and saw BLANCHE M.
GLUNT, the Testatrix, sign and execute the instrument as a Codicil to her Will dated June 26,
1997; that the Testatrix signed willingly and that the Testatrix executed it as her free and
voluntary act for the purposes therein expressed; that each of us, in the hearing and sight of the
Testatrix, signed the Codicil as witnesses; and that to the best of our knowledge the Testatrix was
at that time 18 or more years of age, of sound mind and under no constraint or undue influence.
~<~
Address :2Joo Lo~ "I s c;~ I2ac..J
Ce..r[.s{e PA /70/:S
) {2. ~
Sworn or affirmed to and subscribed before me this 11 tI1 day of October, 2001.
."-:.:;..
~~~~
~~ Public ~
NotarIaJ Seal
~ronIster. Notary Public
Page 3 of 3 Pages My f"___' . 1IIo..CumbertaricfCounty
'"",nnlSSlOn ~XP/res Mar. 14 ?(I05
Member. Penr)sytvania A.~ of IIlota~es
m M&fBank
499 Mitchell Road, MilIsboro, DE 19966 Mail Code DE-MB-12
Phone (888)502-4349
Fax (302) 934-2955
February 15,2007
Stephen L Bloom
Attorney and Counsellor at Law
2100 Longs Gap Road
Carlisle, Pennsylvania 17013
Re: Estate of: Blanche M Glunt
Social Securitv: 199-05-9853
Date of Death: January 24. 2007
Dear Sir or Madam:
Per your inquiry dated February 08, 2007, please be advised that at the time of death, the above-named decedent had on
deposit with this bank the following:
1. Type of Account Checking Account
Account Number 710520
Ownership (Names of) Blanche M Glunt *
Opening Date 09/01/67 Closed 02/01l07
Balance on Date of Death $2,561. 70
Accrued Interest $ 0.10
Total $2,561.80
2.
Type of Account
Savings Account
Account Number
Oj5004198225954
Ownership (Names of)
Blanche M Glunt *
Opening Date
06/28/02 Closed 02/01/07
Balance on Date of Death
$15,775.74
$ 27.13
Accrued Interest
Total
$15,802.87
Please be advised, there was no safe deposit box found for the above decedent. * For further account information,
regarding ownership, closures and/or reimbursement of funds, etc., please call the High Street Carlisle Office # 717-
240-4536.
Sincerely,
~~~/
Nancy Clagett
Records Management
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March 28, 2007
SkphaI L. Bloom
2100 Lon~ Gap Road
Carlisle. PA 17013
llE: &tab: of Blaudae M. G1~ ~
SSN: 199-05-9853
000: 1/24/2007
Deer Mr. Bloom:
In ~se to your t'eQ.uest for Date of Death balances for the customer noted above. out
records show the following:
CJIet'~ ACCOIIJIt
ACCOWlt #5140422769
Established 03/0111976
GUY GLUNT
BLANCHE GLUNT
DOD ba1mce: 539.456.10 + SlS.s6 aecrued interest
The decedent maintained Investment Account (INV #38168494). For further infonnation.,
you may contact the Brok.m'age Department al-1800-162-6111.
Please note that this office only provides date of desth balances for deposit accounts
{lRAs, CDs. Checkinj and SavmlS ~}- We do.. proeest uy ~iaI
traDlacti0a8 or provide statemeDts. If you need assistance with any of these itc..'n1S.
please call1-888-PNC-BANK.(1-888-762-226S) or stop by your 10calPNC Bank.~
office.
Sinc~l~ _
~~
Rache1IeWe&
l..aoo-762.1TIS
P1-PFSC-04-F
500 first Ave.
Pittsburgh PA 1.5219
Membt:r FDIC
TOTAL P. 131
Allstate Life Insurance Company
544 Lakeview Parkway
Vernon Hills, IL 60061
Telephone: (877) 499-6418
Facsimile: (866) 635-4523
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January 25, 2007
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BLACKRoCK
Donna Pollock
PNC Insurance Services
2 E Main St
Mechanicsburg, P A 17055
Re:
Contract No:
Blanche M Glunt
GA2771 04
Dear Ms. Pollock:
We have been requested to complete IRS Form 712 with regard to the above referenced contract. The
purpose of Form 712 is to provide an estate or donor with the value of a life insurance contract or its
proceeds as of a certain date (usually the owner's date of death or date of transfer of the contract).
This contract is an annuity contract, which is not reportable on IRS Form 712. The following information is
provided for estate purposes only as of the date specified:
Date of Death:
Annuity Value* as of Date of Death:
Cost Basis:
Named Beneficiary:
January 24, 2007
$ 13,679.73
$ 13,350.30
Helen Divens, Catherine Morgan,
and Eugene Krugh
*The actual amount paid may differ due to Market Value Adjustments and/or any applicable Surrender
Charges.
If you have any questions, please contact our Customer Care Unit at 1-877-499-6418.
~fi~
Sr. Claim Examiner
Allstate Life Insurance Company
544 Lakeview Parkway
Vernon Hills, IL 60061
Telephone: (877) 499-6418
Facsimile: (866) 635-4523
~Allstate.
FINANCIAL
January 25, 2007
Donna Pollock
PNC Insurance Services
2 E Main St
Mechanicsburg, P A 17055
Re:
Contract No:
Blanche M Glunt
GA0584768
Dear Ms. Pollock:
We have been requested to complete IRS Form 712 with regard to the above referenced contract. The
purpose of Form 712 is to provide an estate or donor with the value of a life insurance contract or its
proceeds as of a certain date (usually the owner's date of death or date of transfer of the contract).
This contract is an annuity contract, which is not reportable on IRS Form 712. The following information is
provided for estate purposes only as of the date specified:
Date of Death:
Annuity Value* as of Date of Death:
Cost Basis:
Named Beneficiary:
January 24, 2007
$ 29,462.68
$ 20,000.00
Helen Divens
*The actual amount paid may differ due to Market Value Adjustments and/or any applicable Surrender
Charges.
If you have any questions, please contact our Customer Care Unit at 1-877-499-6418.
~P1
Donna Gray
Sr. Claim Examiner
Hoffman-Roth Funeral Home & Crematory, Inc.
219 North Hanover Street
Carlisle, P A 17013
(717)243-4511
February 7,2007
Helen Divens
1553 Spring Road
Carlisle, P A 17013
The Funeral Service for Blanche M. Glunt
14946-19
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
OUR SERVICE:
Traditional Funeral Service Package . . '. . . .
FUNERAL HOME SERVICE CHARGES
$3990.00
$3990.00
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
THAT YOU HAVE SELECTED . . . . . . . . . . . . .
$3990.00
Cash Advances
Newspaper Obituary Notice- Sentinel.
Clergy Offering . . . . . . .
Certified Copies of Death Certificates.
Flowers. . . . . . . . . .
Hairdresser. . . . . . . . .
TOTAL CASH ADVANCES AND SPECIAL CHARGES.
$81.90
$100.00
$72.00
$132.50
$30.00
$416.40
Total
Total Cost.
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..
$4406.40
History
01/24/2007 Payment- CREDIT Clergy. . . . . .
02/07/2007 Americo Financial Life & Annuity Ins. Co,
$-100.00
$-3555.38
U~li\:......
$751.02
9
10"
'lUl'AL AMOUNT DUE
101
-100.00 1') I/~ ~
J.-.. <T G~'
$_ _6~~:~~ _ _~ &~:~
To be credited when received from Cumberland County VA
ihis statement is net and payable in full within 30 days of receipt.
0\
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1553 SPR'NG ROAD 9-.
CARUSLE. PA. 17013. .... ......:.:j...........;'........ ......"" ...
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~ Y ABLE
TO:
CARLISLE BOROUGH TAX ACCOUNT
PO BOX 100, 53 WEST SOUTH STREET
CARLISLE, PA 17013
CONTROL NO: 002- 002705
Assessed
Value 0
COUNTY OF CUMBERLAND
Rate 5.00000
CNTY P C
D1KOUnl
2\
4.90
Bill No: 300
Bill Date: 3101/200i
Face
10 %
5.00 5.50
$5.00 $5.50
7/01/2007
TAXPAYER COPY
2007 Statement of Personal Taxes
TAX AMOUNT DUE->
$4.90
ESe:
Xf Paid OIl or Uter
Xf Paid OIl or Before
CASH ONLY ARER 12/15107
UNPAID TAXES SUBMITTED TO DEUNQUENT COLL 12131107
TAX GLUNT, BLANCHE
~YER C/O HELEN DIVENS
1553 SPRING ROAD
CARLISLE PA 17013
y,O tfl:{_ 6 \ o~
?~. ~cc- ,00 ~\'I-\
/~:tc. ~
~ G~
FFICE MONDAY... FRIDAY 8:00AM - 4:00PM
OURS: CLOSED HOLIDAYS
CASH ONLY AFTER 12/15/07
FHONE (717)249-4422
Return Bill with Payment. For a Receipt, Enclose Self Addressed Stamped Envelope.
"
CUSTOMER: BLANCHE M, GLUNT
DATE: 01/31/07
F ACILlTY: SARAH A. TODD MEMORIAL HOME
ACCOUNT:.5702-01-09513
~G~E~CA .
HARRISBURG. PA 17112
PAGE: 1 of 1
PRIMARY PAYOR: MEDICARE- POLlCY#: H54241735 EFFECTIVE DATES: 01/0 1/06-0 1 /24/07
PREVIOUS $ 122.99 PAYMENTS -$122.99 CREDITS: NEW $151.97 ~~~CE $151.97
BALANCE: RECEIVED: CHARGES:
DATE RX NUMBER DESCRIPTION QTY BILLED DUE FROM I INSURANCE CHARGES/
AMT INSURANCE ADJUST CREDITS
Balance Forward: 122.99
Ol/16/07 PAYMENT - THANK YOU -122.99
01/10/07 1587967.03 OYSTER SHELL 500MG + D TA 84.000 6.26 6.26
COPAY OR DEDUCTIBLE PER MEMBER'S MEDICARE
Ol/02/07 1584802.03 CARBIDOPA/LEVO 50/200 EXT 84.000 161.91 Ill.89 45.02 5.00
Ol/03/07 l544841.03 XALATAN 0.005% EYE DROPS 2.500 77.58 31. 98 15.60 30.00
Ol/04/07 1632598.01 SERTRALINE HCL 100 MG TAB 28.000 85.94 6l.75 19.19 5.00
Ol/07/07 1559556.03 ACTONEL 35 MG TABLET 4.000 94.28 49.32 14.96 30.00
Ol/09/07 1663133.00 DIOVAN 80 MG TABLET 28.000 70.06 28.25 11.81 30.00
Ol/10/07 1542700.05 TRAZODONE 50 MG TABLET 28.000 22.36 2.30 15.06 5.00
Ol/B/07 l647955.02 LACTULOSE lO GM/l5 ML SOL 473.000 42.40 9.09 28.31 5.00
01/19/07 1671973.00 NITROGLYCERIN 0.4 MG/HR P 30.000 65.40 45.32 l5.08 5.00
Ol/22/07 l681473.00. MORPHINE SULF 20 MG/ML SO 60.000 47.24 19.69 22.55 5.00
DENIED B CUSTOMER' MEDICARE FOR NDC NOT CO RED (b 1
Ol/22/07 1590780.04 PRILOSEC OTC 20 MG TABLET 28.000 25.71 pel ~,I 25.71
04
Amount Due: . Ck-. I
BILLING QUESTIONS:
08:30 AM - 05:00 PM
PHONE: 800-352-9161
MEDICATION QUESTIONS:
09:00 AM - 04:00 PM
PHONE: 800-994-6337
PAYMENT ADDRESS:
P.O. BOX 6413
CAROL STREAM, IL 60197-64 I 3
Illmll m 1l1li 11m III~I 9 III~ ~II"I [~illlllfifi 11II 111111/1111111111111111
..
...
of
SM 03/08/07 ACCT# 0445
PH# (717) -245-2187
LEDGER CARe
?ROM: O'l/OO/OO TO, 03/08/07
PAGE 1
BLANCHE M GLUNT
SARAH TODD HOME
1000 W SOUTH ST
CARLISLE, PA 17013
SPRING ROAD FAMILY PRACTICE
1921 SPRING ROAD
CARLISLE, PA 17013
(717)-243-5444
LAST BIL: 00/00/00 CURRENT 30 60
_TTL BAL: $0.00 0.00 0.00 0.00
ASIGN'D : $0.00 0.00 0.00 0.00
COLL (Z) : $0.00 0.00 0.00 0.00
WC/NF(W) : $0.00 0.00 0.00 0.00
PERS (*) : $0.00 0.00 0.00 0.00
90
0.00
0.00
0.00
0.00
0.00
LAST PER po:
120+ YTD NCHG:
0.00 YTD PPAY:
0.00 YTD OPAY:
0.00
0.00
0.00
$67.65
$67.65
$67.65
$0.00
on 03/08/07
INS# 2 MEDICARE PA
1 UNITED AMERICAN INS CO
Cov: (*None, !Some)
DR #-NAME
LD. #
2-WILLIAM KAUFFM 25-1801247
RECORD#
FROM/DATE-OF-SERV PATIENT
CPT/HCPCS DESC
FEE DIAG
SCH #1
DIAG
#2
DIAG
#3
L D
I A CLAIM
RECEIPTS
................................................................................................................................................................................. ..
...........................................................................0.....................0..0............................................................................................... ..
12955A
32949A
01/18/07 01/12/07 BLANCHE
03/08/07 01/12/07 BLANCHE
MEDIC DEDUCT(CK#881725131) PAYMENT
CHECK-PERSONAL!CK#1006) PAYMENT
1 2
1 2
N
N
$0.00
$67.65
.......................................................................................0..................................................... ..............................................................
TOTAL RECEIPTS:
$67.65
SIGNATURE:
PLEASE NOTE: FOLD AT . . MARKS FOR STANDARD #10 WINDOW ENVELOPE.
RECEIPTS ONLY, NO CHARGE OR ADJUSTMENT INFORMATION.
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