HomeMy WebLinkAbout04-03-08
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REV.1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes
PO BOX.280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
203 10 2624
10 30 2007
Decedent's Last Name
GROVE
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
Spouse's Social Security Number
15056041147
OFFICIAL USE ONLY
County Code Year
File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT 2 1 0 7
Suffix
Suffix
1012
Date of Birth
09 17 1916
Decedent's First Name
THELMA
Spouse's First Name
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
o 1. Original Return D 2. Supplemental Return
6, Decedent Died Testate
(Attach Copy of Will)
4a. Future Interest Compromise
(date of death after 12-12-82)
o 4. Limited Estate
[RJ
o
CJ
7 Decedent Maintained a liVing Trust
. (Attach Copy of Trust)
10 Spousal Poverty Credit (date of death
. between 12-31-91 and 1-1-95)
o
9. Litigation Proceeds Received
o
3. Remainder Retur1 ,:date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
MI
S
MI
JAMES D. BOGAR
CORRESPONDENT. THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATIOl'1 SHOULD BE DIRECTED TO:
Name
Firm Name (If Applicable)
BOGAR & HIPP LAW OFFICES
First line of address
ONE WEST MAIN STREET
Second line of address
City or Post Office
SHIREMANSTOWN
Correspondent's e-mail address:
State
PA
oc
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8. Total Number of Safe Deposit Boxes
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ADDRESS
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which prepareI' has any knowledge.
SIGNATURE R N RESPONSIBLE F FILING RETURN
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ADDRESS
R. Gary Sipe
17050
James D. Bogar
iremanstown, PA 17011
Side 1
L
15056041147
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11. Election to tax under Sec. 9113(A)
(Attach Sch. 0)
Daytime TelephonE! Number
717 737 8761~
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DATE FILED
ZIP Code
17011
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DATE
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15056041147
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15056042148
REV-1500 EX
Decedent's Name Thelma S. Grove
Decedent's Social Security Number
203 10 2624
RECAPITULATION
1. Real Estate (Schedule A).........
2. Stocks and Bonds (Schedule B)
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) 0 Separate Billing Requested............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) =:J Separate Billing Requested............. 7.
8. Total Gross Assets (total Lines 1-7)................................................................. 8.
1.
2.
2,6S3,689.80
213,593.23
2,867,283.03
1~~,2, 598.55
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).......................
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, of
transfers under Sec. 9116
(a)(1.2) X .00 0 . 0 0
14.
15.
16. Amount of Line 14 taxable
at lineal rate X .045
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
o .00 16.
o .00 17.
2 , 51 7 , 212 . 31 18.
19. Tax Due.........
19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
L
15056042148
8,858.94
131,457.49
2,735,825.54
218,613.23
2,517,212.31
0.00
0.00
0.00
377,581.85
377,581.85
D
15056042148
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REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
Thelma S. Grove
STREET ADDRESS
474 Bethany Drive
File Number 21-07-1012
CITY
: STATE
ZIP
Mechanicsburg
PA
17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
377,581.85
358,137.12
18,849.32
Total Credits (A + B + C)
(2)
376,986.44
3. InteresVPenalty if applicable
D. Interest
E. Penalty
B Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3)
(4)
(5) 595.41
(5AI
(5BI 595.41
TotallnteresVPenalty (D + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 2 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred;..... .......................................................
b. retain the right to designate who shall use the property transferred or its income;...........
c. retain a reversionary interest; or............. .......................... ................................
d. receive the promise for life of either payments, benefits or care?......................... .................
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?................................ ............... .. ... ........................... .................
Yes
o
II
P
No
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3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?..
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?.............................................. ...................... ................ ~ LJ
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 fJr the use of the
surviving spouse is three (3) percent [72 P.S. 89116 (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. 89116 (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. 89116 (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. 89116 1.2) [72 P.S. 89116 (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. 89116 (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.
Rev-1508 EX+ (6-98)
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SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONVVEA.L TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Grove, Thelma S.
FILE NUMBER
21-07 -10'12
ESTATE OF
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 DESCRIPTION
1 AT&T - Refund
VALUE AT DATE
OF DEATH
28.81
2 Bethany Village - Refund
411.00
3 Merrill Lynch Investment Account - No. 872-46745 - date of death balance
2.593.612.66
4 Patriot News - Refund
35.25
5 PNC Bank - Certificate of Deposit No. 31000233213; date of death balance
$26,552.36; accrued interest $42.97
26.595.33
6 PNC Bank - Certificate of Deposit No. 31400241462; date of death balance
$15,214.75; accrued interest $55.60
15,270.35
7 PNC Bank Checking Account No. 500978378 - date of death balance $7,357.92;
accrued interest $0.00
7.357.92
8 PNC Bank Savings Account No. 5000962624 - date of death balance $6,002.48;
accrued interest $0.00
6.002.48
9 Personal Property (Residuary) - items sold at public sale
671.00
10 Personal Property (Residuary) - Items distributed to individuals (antique doll &
cradle - $215.00; two (2) tvs - $25.00; card table - $5.00)
245.00
11 Personal Property (Specific Bequests) - per appraisal
3.460.00
TOTAL (Also enter on Line 5, Recapitulation)
2.653.689.80
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule E (Rev. 6-98)
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214 Senate Avenue, Suite 501
P.O. Box 0810
Camp Hill, Pennsylvania 17011
717975 4600
800975 073S
FAX 717 975 4663
James D. Bogar
Attorney At Law
One West Main Street
Shiremanstown, PA 17011
January 17, 2008
Dear Mr. Bogar,
Please accept this letter as verification that as of October 30,2007, Merrill Lynch held
one account, 872-46745, titled in the single name of Thelma S. Grove. The value of this
account on her date of death, October 30,2007 was $2,593,612.66. Attached are the
details of the assets in this account aiD her date of death October 30,2007.
Ene: Date of Death Valuation
Thelma S. Grove
We are providing the above infarmatian as yau requested. The infarmatian is provided as a service ta you and is .obtained
fram data we believe is accurate. However, Merrill Lynch considers your monthly account statements t.o be thl~ .official
record .of all transactions
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~ PNCBAl'K
November 16, 2007
Ja.TIles D. Bogar
Attorney at Law
One West Main Street
Shiremanstown, PA 17011
RE: Estate of Thelma S. Grove, deceased
SSN: 203-10-2624
000: 10/30/2007
Dear Mr. Bogar:
In response to your request for Date of Death balances for the customer noted above, our
records show the following:
Certificates of Deposit
Account #31000233213
THELMA S GROVE
DOD balance: $26,552.36 + $42.97 accrued interest
Account #31400241462
THELMA S GROVE
DOD balance: $15,214.75 + $55.60 accrued interest
Checking Account
Account #5000978378
THELMA S GROVE
DOD balance: $7,357.92 + $0.00 accrued interest
Savings Account
Account #5000962624
THELMA S GROVE
DOD balance: $6,002.48 + $0.00 accrued interest
Page 1 of2
Established 04/16/2003
Established 06/03/2004
Established 12/31/1998
Established 06/1 0/1999
Please note that this office only proyjdes date of death balances for deposit accounts
(IRAs, CDs, Checking and Savings accounts). We do not process any financial
transactions or provide statements. If you need assistance with any of these items,
please call1-88S-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch
office.
Sincerely,
C?Jod&11J/iJ~
Rachelle Wells
}-800-762-1775
P7-PFSC-04-F
500 first Ave.
Pittsburgh PA 15219
Page 2 of2
Member FDIC
To:
James D. Bogar, Attorney
One West Main Street
Shiremanstown, P A 17011
From:
William G. Rowe, Appriaser
211 Old Stone House Road
Carlisle, PA 17015
Re:
Personal Property Appraisal
Estate of Thelma S. Grove
474 Bethany Drive
Mechanicsburg, PA 17055
Date of Death - October 30, 2007
Date:
November 20, 2007
Appraisal sequence by Will and Testament
SECOND - Lucille Sipe Wilt
Hutch
THIRD - Betty Grove McCauslin
Corner cupboard
Set of dishes
Knick knacks
Davenport and loveseat
Glider rocker
Bedroom suite
Chest of drawers
Selection of costume jewelry
FOURTH - Eric G. Grove
American flag in case with medals
FIFTH - Cindy K. Sowers
Small black stand and mirror
SIXTH - Suzanne Wilt Schmitt
White crochet afghan with pink flowers
SEVENTH - Joan" Wilt Lower
Log cabin afghan
EIGHTH - Daniel Edward Grove
Grove farm picture
NINTH - Bethanv VillaQe
Sewing machine
TENTH - Dale R. Grove
End table and light
Grove Appraisal
liNDEN HALL ANTiQUES
211 OLD STONE HOUSE ROAD
CARLISLE, PA 17015
717 -249-1978
$120.00
$125.00
$150.00
$20.00
$300.00
$50.00
$300.00
$35.00
$165.00
$65.00
$85.00
$20.00
$20.00
$30.00
$20.00
$50.00
11/20/2007
Silverware
Black antique chair
Glass candle holders (on corner cupboard)
Clock on shelf
Wooden set of buildings (crafts)
ELEVENTH - Joyce Sowers Irvin
Watch with diamond chips - 14K (Pulsar)
Diamond ring - white gold with diamond chips
Wedding band - white gold with diamond chips
Cedar chest
TWELFTH - Rvan T. Sipe and Tvler R. Sipe
Curio cabinet
Hummel figurines (7)
Plates (10) - Royal Copenhagen
THIRTEENTH - Penny Sowers Davis
Dining room table and 4 chairs
RESIDUARY ESTATE PROPERTY
Knick knacks
2 chairs
Chest of drawers
Desk / chair
Sewing chest / sewing items
Card table, mahogany
Chest of drawers
Christmas items
Miscellaneous household (storage area)
Doll cradle & antique doll
Lamps
Planter
Glassware (curio)
Footstools (2)
T.v.s (2)
Kitchenwares / dishes
Recliner
Child's chairs (2)
Srlelf - knick knack
GARAGE:
Cabinet
Card table
Tools
Table, extension - boards
Chairs (2)
Rack
Knick knacks
Grove Appraisal
$25.00
$45.00
$25.00
$25.00
$20.00
$115.00
$185.00
$150.00
$90.00
$300.00
$675.00
$100.00
$150.00
$15.00
$20.00
$25.00
$50.00
$20.00
$45.00
$15.00
$5.00
$15.00
$215.00
$10.00
$25.00
$115.00
$30.00
$25.00
$15.001
$30.00
$20.00
$15.00
$10.00
$5.00
$10.00
$150.00
$10.00
$15.00
$10.00
-]'" ....-)..., ........ """.-,,-- -:::> '..~..~~... ~--=
William G. Rowe
2
"
;.~-~~._--_......._.."..
11/20/2007
ROWE'S AUCTION SERVICE (RH 79L)
Bill Rowe (AU 1538L)
2505 Ritner Highway · Carlisle, PA 17015
249-1978 697-4794 249-2677
Dave Rowe (AU 2295L)
Auction Is Action Call "Rowe" For Satisfaction
SELLERS NAME-r-U~ ,:::::;-_< .c' '..""-
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DATE >:.:::>(:>~:n I. .;~, L(~,,-,
PHONE''"":' ':: '-, >;:c "';: r: "
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AUCTIONEER % 3, "S
ADDRESS
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OTHER
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AUCTION DATE/LOCATION C/- /":;/<..:(.c ,} /,/'.i /,;1
,/
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CLERK-,%
DESCRIPTION OF MERCHANDISE
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I Commission the Auctioneers to sell the merchandise to the highest bidder by Public Auction. Merchandise
to be sold as is & ~louped as necessary to obtain bids. I certify that I am the owner or authorized represen-
tative of the merchandise, goods and or property and have good title and the right to sell and that they are free
from all incumbrances. I agree to accept all responsibility for providing merchantable title and for delivery of
title to the purchaser. I agree to hold harmless the Auctioneers against any claims of the nature referred to in
this agreement.
,~~.......~ \\
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AUCTION S'IGNATURE
SELLERS 'SIGNATURE
Total Sales (Clerking Tickets Attached) $
k -,- 0.:7
. '. s:: \ --'"--"
Less Sale Expense:
- '-\1.....~ ... cg~
'>c:' % Commission Auctioneer $ ~,*'l> -~'-' ..
% Commission Clerks $ __
OTHER:
'-'"..;"',-':-.-~,~
56
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,0
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TOTAL SALE EXPENSE DEDUCTED $
SELLERS NET $
."")89
0- '. ...
D2~~~ 0;~-22-~~~0~t~ ~2;3114~e~
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~12chanicsbu~~g PA
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Rev-1510 EX+ (6-98)
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONW""t::AL TH OF PENNSYLVANIA
INHERITANCE T P\X RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
21-07 -1012
Grove, Thelma S.
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET IS yes
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECO'S EXCLUSIO
NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLlCAE:
THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE
1 United Methodist Stewardship Foundation 213.593.23
Charitable Gift Annuity - Date of Death Value -
$213,593.23 - date of death value per attached
letter (Copy of Annuity Agreement attached)
TOTAL (Also enter on Line 7, Recapitulation)
(If more space is needed, additionai pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
N TAXABLE
L1o) VALUE
213.593.23
213,593.23
Form PA-1500 Schedule G (Rev. 6-98)
00SHIP f:::
~'r' q~1
/!i '6
0J Y,
w ='
J:. 0
y <:
planned giving
is joyful sharing
17:Je Urlited Methodist
STEWARDSHIP FOUNDATION ofCentralPennsvlvania
Proudly Celebrating our Foundation's 15th Anniversary
303 Mulberry Drive . Suite 300 . Mechanicsburg, Pennsylvania 17050-3141
(717) 766-7343 . (800) 272-0113 . Fax: (717) 766-1673 . Email: sfcpa@netrax,net .. umstewardship.org
Member of American CouncU on Gift Annuities,
Association of Fund Raising Professionals, and
National Association of United Methodist Foundations
March 25,2008
Mr. James D. Bogar
Attorney at Law
One West Main Street
Shiremanstown P A 17011
Dear Mr. Bogar:
Please find enclosed copies of Thelma Grove's Charitable Gift Annuity Agreement and all
supporting documentation. The value of the gift annuity as of October 30,2007, the date of
Thelma's death, was $213,593.23.
Please contact me if you have any questions on the above.
Faithfully,
A ~
,>) .", ","'!::- /;, t< '!I. "PI/; ~
It'.), (,,\,;\.... i' I - .S7t l/(A,t.d-"
The R~v. Phyllis M. Bowers
Executive Director
PMB:kal
Enc!.
"lnvest11~ent Management and Stewardsbip Services"
Tbe United Methodist
STEWARDSHIP FOUNDATION
of Central Pennsylvania
GIFT ANNUITY AGREEMENT
The United Methodist Stewardship Foundation of Central
Pennsylvania, a Pennsylvania nonprofit corporation and exempt
from federal income taxes as an organization described in Section
501 (c) (3) and Section 170 (c) of the Internal Revenue Code of
1986, as amended ("The Foundation") acknowledges the receipt of
$1,014,741.63 contributed to it by Thelma S. Grove (the "Donor")
as a charitable gift.
In consideration of and for said gift, The United
Methodist Stewardship Foundation of Central Pennsylvania, hereby
agrees to pay an annuity of $81,179.36 per year, in equal
quarterly installments of $20,294.84, to Thelma S. Grove for
life. The first installment shall be payable on
February 10, 2000.
The obligation of The United Methodist Stewardship
Foundation of Central Pennsylvania, to make annuity payments
under this agreement shall terminate with the regular payment
preceding the death of the above-named annuitant. This annuity
is non-assignable.
At the death of the annuitant, the residue of the
aforesaid gift shall be paid to The United Methodist Stewardship
Foundation of Central pennsylvania, 900 South Arlington Avenue,
Suite 128, Harrisburg, Pennsylvania 17109 to be placed in the
Glenn B. and Thelma S. Grove Memorial Fund. The net income from
this Fund will be for the benefit of Shiremanstown United
Methodist Church, 125 East Main Streetl Shiremanstown,
Pennsylvania 17011. The general purposes for which the net
income may be used will be listed in a memorandum from the donor
enclosed in this file.
The Donor and The Foundation acknowledge that as of the
date of this Agreement, the fair market value of the property
transferred to The Foundation is substantially in excess of the
fair marke~ value of the annuity and that the difference between
those values constitutes a gift by the Donor to The Foundation
for its (t~eir) charitable purposes. The Donor acknowledges
being advised by The Foundation that a charitable gift annuity is
not designed primarily as an investment but rather as a
charitable gift, and that the promise to pay this annuity is not
Page 1 of 2
Date 11-./J.-99'
9O:J South Arlingtontwenue, Suite 128 . Harrisburg, PA 17109 . (717) 652-3030 . 1-8CXJ.-272-O 113 . Fax: (717) 652-3233
insurance under the laws of Pennsylvania, is not subject to
regulation by the Pennsylvania Insurance Department and is not
protected by The Pennsylvania Life and Health Insurance Guaranty
Association under Article XVII of the Act of May 17, 1921
(P.L. 682, No. 284), known as the Insurance Company Law of 1921,
or other protective device.
The United Methodist Stewardship Foundation of Central
Pennsylvania was established August 5, 1993. Donors may contact
The Foundation's Executive Director at 900 South Arlington
Avenue, Suite 128, Harrisburg, Pennsylvania 17109 to obtain a
copy of The Foundation's organizational documents showing its
status as a charitable organization described in Section 170(c)
of the Internal Revenue Code of 1986 or any successor provisions,
and a copy of its most current audited financial statement.
Attached is a copy of the Gift Annuity Application by
the Donor. The provisions of this Application are incorporated
by reference and are made a part of this Agreement.
In witness whereof, The Foundation has signed this
instrument this 1;;"-"'''' day of !VeJoJc'''-I.IDe.r- , 19~.
The United Methodist StewardBhip
Foundation of Central Pennsylvania
By:
z~ w. ,J-~=L/~
t> Treasurer
Page 2 of 2
SF - SL
Tlje [7Ylited lk1etlJodist
,0_ __ _or-; . ..,--"....,
~.~, '\"7 'i 'Q '"'" " 'T ,-",
~ ~2' l.J 1 L ~A rll\..L~utill'--"
p{--Y'f n. iT' '~'T'T ~r 1\.T
Ii '. I., . [\,U' Ai' I ,I"
l ~~ h...._J 1. ~" '.L JL JL ..i.. ''-J' 1. ~
c~f'
~ .-,_./'>....'1 .-'11'-'.1 "'''7/ '
rei tl&0..t.at 'va
Jj ~ hereby apply for a Gift Annuity Agreement in the amount of
'If I. C J Lf . '7 '"i i , & 3 , with annuity payments to be made to the person
named'below as long as he or she lives:
Name
Thelma S. Grove
Address
474 Bethany Drive
City
Mechanicsburg
State
PA
Zip
17055
Date of Birth
September 7, 1916
Soc. Sec. No.
203-10-.2624
(If applying for a single-life annuity, leave the following
section blank.)
Should the person named below survive the one named above, then
annuity payments are to be made to this person as long as he or
she lives:
Name
F.ddre s s
City
State
Zip
Date of Birth
Soc. Sec. No.
Annuicy payments Annually
are to be made (Check one)
Semi-AnnuallY-1LQuarterly _]V[onthly
Upon maturity, the funds in this Gift Annuity are to be pa.id to
The United Methodist Stewardship Foundation of Central
Pennsylvania, 900 South Arlington ]wenue, Suite 128, HarriE3burg,
Pennsylvania 17109 to be placed in the Glenn B. and Thelma S.
Grove Memorial Fund. The net income from this Fund will be for
the benefit of Shiremanstown United Methodist Church, 125 East
Main Street, Shiremanstown, Pennsylvania 17011. The general
purposes for which the net income may be used will be listed in a
memorandum from the donor enclosed in the file.
Stock from Thelma S. Grove's Merrill Lynch and IDS account will
be transfe~red to The United Methodist Stewardship Foundation to
fund the Gift Annuity Agreement. The stock will be listed on a
separate sheet attached to this Application.
Page 1 of 2
Date jV6 \) i";' 1" "?? Donor I s Initials
qCC SC<jth .A,r!i:,~~'-;::;~ ].\/enU8, Su\te : 28 ~ Hcrrisburg, PP., 171 Cq (; (7 ~ 7) 652-.3030 c 1-8-00-272-0 ~ i 3 <; ~;=/: 7':: c)52-.32-33
I understand that this application shall be considered as part of
the Gift Annuity Agreement and shall be incorporated therein by
this reference.
I acknowledge that:
(1) I have received The Stewardship Foundation's
Gift Annuity Brochure and The Stewardship
Foundation's most recent Annual Report..
(2) The fair market value of the property to be
transferred to The Stewardship Foundation
will be substantially in excess of the fair
market value of an annuity and that the
difference between those values constitutes
a charitable gift by me.
(3) A charitable gift annuity is not designed
primarily as an investment but rather as a
charitable gift.
(4) The Stewardship Foundation's promise to pay
an annuity is not insurance under the laws of
the Commonwealth of Pennsylvania, is not
subject to regulations by the Pennsylvania
Insurance Department and is not protected by
the Pennsylvania Life and Health Insurance
Guaranty Association under Article XVII of
the Act of May 17, 1921 (P.L. 682, NO.284),
known as the Insurance Law of 1921
or other protective device.
I understand that this application shall be considered
as part of the Gift Annuity Agreement and shall be incor-
porated therein by this reference.
Date
l\J~? \/ j J..
. '\0.,' ~ )
, ..." -- -
i '1 ~. ~i
,'f-,l\ /; {I f
1 ~'/ \l./~ \j /i "
Signed .~~ r~~y ~~
~~/
l3'7..(;7/'/_
/
JY..21,.",..v
/c,>~.[~!i~
Page 2 of 2
SF - SL
Tbe United lvIethodist
P r\ T Ti\. TT\ ^..,.-..T~, 1" T
1- 'U Ul "iLJr.s..ll\Jl'~
ell
.Pet? J1S)-'!Z)(IJ1-icf
~~
""",.,.....,.,n\"(;Vn A R!!"" 5T TT. n
,~_ ,,-' ~ ~ ~. ~. II}: ~ ~ e-
~,);,: t,0 I~~ >l8' JL~~!i
__ ....t:.... ~ v' _ ....Lo..._ 'l!...~ ---
THELMA S. GROVE
Attachment to Gift Annuity Application
Stock Transferred November 12, 1999
NAME OF STOCK SHARES VALUE COST BASIS
Bell Atlantic Corp. 2,144 $135,676.61 $ 0
Home Depot, Inc. 561 44,722.36 9,272.77
Lucent Technologies 600 44,400.00 0
SBC Communications, Inc. 2,500 128,205.00 18,624.00
V odafona Airtouch SP 1,330 63,840.00 0
MUTUAL FUNDS
IDS Stock Fund
1,887.165
$219,027.13 72,034.00
52,060.80 21,108.00
256,346.75 99,830.00
54,010.67 42,721.64
16,452.31 16,227.52
---
$1,014,741.63 $279,817.93
Lord Abbett Affiliated Fund
13,139
Phoenix Equity
5,423
V anguard Wellington Fund, Inc.
8,525
IDS Investment Services, Inc.
1,211.510
90Ci Sou~'h F.r!!r-'Q~,:::.:r-: ..;venue, Su[i'e 128 ~ Harrisburg, PP, 17109 e (717) 652-3030 e 1-800-272-011.3 e cc/ 'i -:;) .S,52-.3233
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TO THE STEWARDSHIP FOUNDA DON
IN REFERENCE TO MY CHARITABLE GIFT ANNUITY
IN THE SUM OF ONE MILLION DOLLARS ( $ 1,000,000.00)
DEAR SIRS,
I HAVE MADE GIFT WORTH APPROXIMATELY ONE MILLION DOLLARS TO
THE STEW ARDSillP FOUNDA DON AS CHARITABLE ANNUITY GIFT. THIS GIFT IS
SOLEL Y FOR THE BENEFIT OF MY CHURCH, THE SillREMANSTOWN UNITED
METHODIST CHURCH. LOCATED IN SHIREMANSTOWN, PA, AS FOLLOWS:
1. MY GIFT IS FOR THE EXCLUSIVE BENEFIT OF MY CHURCH, ITS
PURPOSES AND ITS MISSIONS IN THE SERVICE OF OUR LORD JESUS CHRIST.
2. ONLY THE NET INCOME FROM MY GIFT IS TO BE UTILIZED EACH
YEAR FOR MY CH;URCH, ITS PURPOSES AND MISSIONS IN THE SERVICE OF OUR
"
LORD JESUS CHRIST.
3. THIS LETTER SHOULD ONLY BE INTERPRETED IN FAVOR OF MY
CHURCH AND IN FA VOR OF PRESERVING THE CP..PJUT ABLE GIFT NA TURE OF MY
GIFT.
4. THIS LETTER IS AN INDICATION OF MY DESIRES FOR THE
SUGGESTED DSES OF THE NET INCOME FROM MY CHARITABLE ANNUITY GIFT
FOR MY CHURCH AND BY MY CHURCH, AND MY LETTER SHOULD BE READ
BROADL Y AND LIBERALLY IN ORDER TO HELP PROMOTE MY CHURCH, ITS
PURPOSES AND MISSIONS IN THE SERVICE OF OUR LORD JESUS CHRIST. MY
LETTER IS ONLY SUGGESTIONS TO INDICATE MY DESIRES FOR THE CHURCH'S
PURPOSES, MISSIONS AND SERVICE. THEY ARE NOT REQUIREMENTS AS I MUST
REL Y ON THE CHURCH'S ADMINISTRATION BOARD'S GOOD nJDGMENT IN THE
SERVICE OF OUR LORD.
5. THE NAME OF MY GIFT WILL BE THE GLEN1'-J B. AND THEUvJ:A S.
GROVE MEMORIAL FUND.
6. FIRST, I WISH TO HELP THE GENERAL CHURCH FUND WITH MY
GIFT'S INCOME. I HAVE BELONGED TO THE SHIREMANSTOWN UNITED
METHODIST CHURCH FOR 70 YEARS AND I HAVE BEEN A VOLUNTEER WORKER
n~ THE CI-rLJRCH FOR ALL MY LIFE SINCE I WAS 12 YEARS OF AGE.. I RAVE
OBSERVED 'IRA T OUR OPERA TfNG FUNDS ARE AL WAYS SHORT. THEREFORE, I
WANT PART OF THE INCOME FROM MY GIFT TO BE PAID INTO THE CHURCH'S
GENERAL FUND TO HELP ITS OPERATING CHURCH BUDGET OR FUND.
7. SECOND, I HAVE WITNESSED THE YOUTH MINISTRY FLOURISH AND
GROW UNDER THE LOVE AND GUIDANCE OF RUTH DIETZ. RUTH IS THE
DAUGHTER OF MY FORMER PASTOR AT THE CHURCH, REV. GUY BAER IT IS SO
WONDERFUL TO SEE THE YOUTH GROUP GROWING AND DOING SO MANY
ACTIVITIES, SUCH AS THEIR MISSION TRIP TO HELP A WORK CAMP IN VilEST
VIRGINIA THIS PAST SUMMER OF 1999. THE YOUTH ARE OUR FUTURE.
AL THOUGH MY LATE HUSBAND GLENN AND I DID NOT HAVE CHILDREN, WE
LOVED THE CHILDREN IN OUR CHURCH. THEREFORE, I WANT PART OF THE
INCOME FROM MY GIFT TO BE PAID TO THE CHURCH FOR THE YOUTH MINISTRY
AT MY CHURCH. THE YOUTH MINISTRY MAYBE BROADLY DEFINED AS THE
JUNIOR (MIDDLE) AND SENIOR HIGH SCHOOL YOUTH AND! OR THEIR SUNDAY
SCHOOL CLASSES.
8. THIRD, I HAVE WITNESSED HOW MUCH WE NEED TRANSPORTATION
A T OUR CHURCH. OUR CHURCH PROVIDES TRANSPORTATION TO RESIDENTS OF
BETHANY VILLAGE TO OUR WORSHIP SERVICES; TRANSPORTATION FOR THE
YOUTH ACTIVITIES INCLUDING THEIR TRIPS TO YOUTH WORSHIP RALLIES,
MISSION SERVICE, THE CHILDRENS' HOME, BETHANY VILLAGE TRIPS, ETC. ETC.;
AND, TRANSPORTATION FOR OUR OTHER CHURCH GROUPS. I WOULD LIKE PART
OF THE INCOlvfE TO BENEFIT THE CHLTRCH'S TRANSPORTATION NEEDS.
9. FOURTH, I HAVE WITNESSED TIm DEVELOPMENT OF A HEALTH
MINISTRY IN OUR CHURCH. THE CHURCH'S HEALTH MINISTRY IS JUST
BEGINNING TO GIVE SEMINARS, TO DO BLOOD PRESSURE TESTINGS AND ASSIST
PERSONS WHO ARE IN NEED OF TRANSPORTATION, INFORMATION OR WHO ARE
SHUT IN. I WOULD LIKE PART OF THE INCOME TO BENEFIT THE CHURCH'S
HEALTH MINISTRY.
10. FIFTH, SINCE CHILDREN ARE VERY IMPORTANT TO ME AND SINCE
IT IS IMPORTANT TO GET CHILDREN INVOLVED AS EARLY AS POSSIBLE IN
LEARNING ABOUT OUR LORD JESUS CHRIST, I WANT PART OF THE INCOME FROM
MY GIFT TO BENEFIT THE CHURCH'S MISSION OF SERVING AND EDUCATING THE
CHILDREN OF MY CHURCH AND THE COMMUNITY. I MUST LEAVE HO\V
CHILDREN ARE SERVED AND EDUCATED UP TO THE CHURCH'S ADMINISTRATION
BOARD, BUT I THINK THAT WAYS OF SERVING CHILDREN'S NEEDS SHOULD BE
INVESTIGA TED, HELPING THE CHILDREN BECOME INVOLVED TN SUNDAY
SCHOOL CLASSES, BIBLE STUDY CLASSES OR WORSHIP WOULD BE BENEFICIAL,
AND HELPING THE KIDS CLUB WHICH TEACHES THE YOUNGER KIDS OR THE
JUNIORS FOR JESUS WHO ARE IN 5TH, 6TH AND 7TH GRADES. PART OF THE
CHURCH'S MISSION HAS BEEN TO REACH OUT TO THE CHILDREN IN THE
COMMUNITY AND I WOULD HOPE THE CHURCH COULD CONTINUE THIS ~tfISSION,
SUCH AS V ACA TION BIBLE SCHOOL, WHICH I USED TO TEACH MANY YEARS AGO.
"
11. SIXTH, SUNDAY SCHOOL HAS AL WAYS BEEN IMPORTANT TO ME. I
WOULD WANT PART OF THE INCOME FROM MY GIFT TO BENEFIT THE CHURCH'S
OVERALL SUNDAY SCHOOL AND CHRISTIAN EDUCATION PROGRAMS.
12. SEVENTH, I HAVE ENJOYED SEEING THE WAYS OUR CHURCH HAS
REACHED OUT TO HELP OUR COMMUNITY. I BELIEVE THERE IS SO MUCH THE
CHURCH CAN DO TO HELP THE COMMUNITY AND ITS CHILDREN, ITS NEEDY, ITS
HUNGRY, ITS~HOMELESS, ITS SICK. I WOULD WANT PART OF THE INCOME FROM
MY GIFT TO BENEFIT THE CHURCH'S ACTIVITIES AND ENDEAVORS WHICH
REACH OUT TO HELP THE COMMUNITY, AS OUR LORD JESUS CHRlST WOULD
WANT US TO DO. FOR EXAMPLE, I HAVE NOTICED THAT FAMILIES IN NEED
SUNDA Y ONL Y RECEIVES A SMALL DONATION EACH YEAR. I CONSIDER THIS AN
IMPORTANT PART OF THE CHURCH'S MISSION.
13. EIGHTH, I HAVE WITNESSED OUR CHURCH DEVELOP ITS WORLD
WIDE MINISTRY. Th1:S IS SO WONDERFUL, ESPECIALLY SINCE THE GRO'WTH OF
THE UNITED METHODIST CHURCH IS GROWING FASTER IN FOREIGN COUNTRIES
RATHER THAN IN THE UNITED STATES. MY CHURCH IS HELPING THE MINISTRY
IN STATE COLLEGE WHICH SERVES VISITORS FROM CHINA AND TEACHES THEM
ABOUT JESUS CHRIST. MY CHURCH ALSO HELPS OTHER MINISTRIES SUCH AS IN
NIGERIA. THE APOSTLE PAUL TOLD US TO WITNESS TO EVERYONE. I WOULD
WANT PART OF THE INCOME FROM MY GIFT TO BENEFIT MY CHURCH'S WORLD
V/IDE M[~lSTRY PROGRAl\l1.
14. NINTH, I WOULD WANT PART OF THE INCOME FROM MY GIFT TO
BENEFIT THE BEAUTIFUL MUSIC PROGRAM AND THE BEAUTIFUL FLOWERS WE
ENJOY AT OUR SHlREMANSTOWN UNITED METHODIST CHURCH. I WOULD WANT
PART OF MY GIFT'S INCOME TO BENEFIT THE CHURCH'S MUSIC PROGRAM AND
HELP PURCHASE FLOWERS FOR THE CHURCH, IF NEEDED, TO HELP DECORATE
AND BEAUTIFY THE CHURCH.
15. TENTH, I BELIEVE THAT THE MESSAGE OF OUR LORD AND SAVIOR
JESUS CHRIST MUST BE SHARED. THEREFORE, I WOULD WANT PART OF THE
INCOME FROM MY GIFT TO BENEFIT THE CHURCH'S EV ANGELISM WORK. THERE
ARE SO MANY WAYS THE CHURCH COULD SHARE THE WORD OF OUR LORD.
16. ELEVENTH, I HAVE ENJOYED WORKING WITH THE PASTORS OF OUR
CHURCH OVER THE YEARS. I KNOW FROM WORKING IN THE CHURCH OFFICE
THAT THE PASTORS ARE VERY CAREFUL ABOUT WHAT PURCHASES THEY
WOULD LIKE TO HAVE ON BEHALF OF THE CHURCH AND SOMETIMES THEY
HA VE TO SACRIFICE BECAUSE OF COST. I WOULD WANT PART OF THE INCOME
TO BE ABLE TO BE"t\TEFIT THE CHURCH TO FULFILL SOME OF THE REQUESTS OF
THE PASTORS FOR THE PURCHASE OF BOOKS OR VIDEOS, COMPACT VIDEOS,
COMPUTER SOFTWARE, ETC., OR WHATEVER MEDIA IS APPROPRIATE, AS WELL
AS HELPfr~G THE Cnu'RCH PROVIDE CONTINUING EDUCATION FOR THE PASTOR
AND OR THE CHlJR.CH'S STA1~F, INCLUDING TRAVEL AND RELATED COSTS AND
EXPENSES, WHICH THE PASTOR WOULD LIKE TO HAVE FOR THE CHURCH'S
MINISTRY WHICH COST MIGHT NOT BE ABLE TO BE AYFORDED IN THE GENERAL
OPERA TING BUDGET.
17. THE CHURCH IS DEVELOPING A CHRISTIAN DA YCARE PROGRAM FOR
CHILDREN TO PROVIDE A LOVING CHRISTIAN LEARNING ENVIRONMENT FOR
CHILDREN WHO ARE PLACED THERE. THIS DA YCARE IS AN IMPORTANT
OPPORTUNITY FOR BOTH THE CHILDREN AND THE CHURCH IN THE SERVICE TO
THE LORD. I WOULD WANT PART OF THE INCOME, IF NEEDED, TO BENEFIT THE
CHURCH'S DA YCARE PROGRAM.
18. I WOULD WANT PART OF THE INCOME FROM MY GIFT TO BE ABLE
TO BE USED FOR THE PROPER UPKEEP AND MAINTENANCE OF OUR CHURCH'S
BUILDINGS AND PROPERTIES, AS WELL AS THE IMPROVEMENT, PURCHASE OR
ADDING ON TO THE CHURCH'S BUILDINGS OR PROPERTIES.
IN SUMMARY, IT IS MY PRECATORY DESIRE THAT THE GIFT TI-T.AT CAME
FROM MY HUSBAND'S AND MY HARD WORK AND SACRIFICE AND GOOD
FORTIJNE FROM GOD'S RICH BLESSINGS UPON US TO BE USED TO HELP MY
CHURCH IN ITS SERVICE TO OUR LORD JESUS CHRIST AND HELP TO CARRY HIS
WORD AND MESSAGE SO THAT OTHERS MAY KNOW AND SHARE IN HIS LOVE.
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REV-1151 EX+ (12-99)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Grove, Thelma S.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-07 -1012
ESTATE OF
ITEM
NUMBER
A. FUNERAL EXPENSES:
DESCRIPTION
AMOUNT
Myers Funeral Home, Inc. - balance due for funeral
345.00
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
B.
R. Gary Sipe
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address 1216 Kings Circle
City Mechanicsburg
Year(s) Commission paid
State P A Zip 17050
62,805.00
2.
Attorney's Fees
Bogar & Hipp Law Offices
49,500.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Zip
4
Probate Fees
614.00
5
Accountant's Fees
1,410.00
6 Tax Return Preparer's Fees
7.
Other Administrative Costs
7,924.55
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation)
122,598.55
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
Rev-1502 EX+ (6-98)
i*
SCHEDULE H.A
FUNERAL EXPENSES
continued
COMMONWE6,LTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Grove, Thelma S.
IFILE NUMBER
21-07 -1012
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Myers Funeral Home, Inc. - balance due for funeral
345.00
Subtotal ,
345.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
Rev-1502 EX+ (6-98)
SCHEDULE H-B5
ACCOUNTANT'S FEES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Grove, Thelma S.
IFILE NUMBER
21-07 -1012
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
R. Wm Wire Associates, P.C. - Fee for preparation of 2007 Federal and State
Personal Income Tax Returns
1,410.00
Subtotal
1,410.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B5 (Rev. 6-98)
Rev-1502 EX+ (6-98)
SCHEDULE H.B7
OTHER
ADMiNiSTRATiVE COSTS
continued
COMMONWEJ\L TH OF PENNSYLVANLA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Grove, Thelma S.
IFILE NUMBER
21-07 -1012
ESTATE OF
ITEM
NUMBER DESCRIPTION
1 Bethany Village - November payment
9 PPL - electric bill
AMOUNT
I 867.00
867.00
I 75.00
150.00
24.59
16.21
48.28
59.85
44.54
5.00
5.000.00
277 .85
114.30
364.00
10.93
2 Bethany Village - December payment
3 Cumberland Law Journal - Executor's Notice
4 Linden Hall Antiques - personal property appraisal
5 PA American Water - water bill
6 PA American Water - water bill
7 PPL - electric bill
8 PPL - electric bill
10 Register of Wills - Certified copy of Will
11 RESERVES - Cost to conclude administration of Estate including filing of PA
Inheritance Tax Return and Inventory and fiduciary income tax returns
12 Rowe's Auction Service - Auctioneer's commission and hauling fee
13 The Patriot News - Executor's Notice
14 Trash Hauling
15 Verizon - phone bill
Subtotal
7.924.55
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B7 (Rev. 6-98)
Rev-1512 EX+ (6-98)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABiLITiES, & LIENS
COMMONWeALTH OF PENNSYLVANIA,
INHERITANCE TAX RSTURN
RESIDENT DECEDENT
Grove, Thelma S.
FILE NUMBER
21-07-1012
ESTATE OF
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1
Alert Pharmacy
81.10
2
Associated Cardiologists - medical bill
81.04
3
Camp Hill Emergency Physicians - medical bill
32.17
4
ENT Surgery Group - medical bill
11.34
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Hampden Physician Associates - medica! bill
24.26
6
Hampden Physician Associates - medical bill
85.31
7
Holy Spirit Hospital - medical bill
1.000.05
8
Kilmore Eye Associates - medical bill
42.67
9
Pennsylvania Department of Labor - 4th quarter personal income tax payment
750.00
10
Quantum Imaging Associates - medical bill
751.00
11
United States Treasury - 4th quarter personal income tax payment
6.000.00
TOTAL (Also enter on Line 10, Recapitulation)
8,858.94
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule I (Rev. 6-98)
REV 1513 EX+ (9-00)
.~
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SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
Grove, Thelma S.
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116(a)(1.2)]
RELATIONSHIP TO
DECEDENT
Do Not List Trustee(s)
I.
See attached schedule
FILE NUMBER
21-07 -1012
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
Total
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
II. NON-TAXABLE DISTRIBUTIONS:
A SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
See continuation schedule(s) attached
Copyright (c) 2002 form software only The Lackner Group, Inc.
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Form PA-1500 Schedule J (Rev. 6-98)
218,613.23
218,613.23
SCHEDULE J
BENEFICIARIES
(Part I, Taxable Distributions)
ESTATE OF:
Thelma S. Grove 10/30/2007 203-10-2624
Item Name and Address of Person(s) Share of Estate
Number Receiving Property Relationship (Words)
Amount of Estate
($$$)
1 Kimberly J. Anderson Sipe
1216 Kings Circle
Mechanicsburg, PA 17050
Niece
Thirty percent of rest,
residue and
remainder
2 Penny Sowers Davis
228 N. Main Street
York Springs, PA 17372
Niece
specific bequest
3 Marlene Sipe Dougherty
910 Sterling Court
Enola, PA 17025
Niece
specific bequest
4 Dale R. Grove
237 Hickory Road
Littlestown, PA 17340
Brother-in-Law
Fifteen percent of
rest, residue and
remainder & specific
bequest
5 Daniel Edward Grove
401 N. 5th Street
Lemoyne, PA 17043
Nephew
specific bequest
1
SCHEDULE J
BENEFICIARIES
(Part I, Taxable Distributions)
ESTATE OF:
Thelma S. Grove 10/30/2007 203-10-2624
Item Name and Address of Person(s} Share of Estate
Number Receiving Property Relationship (Words)
Amount of Estate
($$$)
6 Eric G. Grove
7 Maple Place
Andover,NJ 07821
Other
specific bequest
7 Joyce Sowers Irwin
86 White Oak Tree Road
York Springs, PA 17372
Niece
specific bequest
8 JoAnn Wilt Lower
1365 Old Quaker Road
Etters, PA 17319
Grand Niece
specific bequest
9 Betty Grove McCauslin Sister-in-Law Fifteen percent of
181 Dug Hill Road rest, residue and
Biglerville, PA 17307 remainder and
specific bequest
10 Joette Schafer Friend specific bequest
503 Katrina Court
Mechanicsburg, PA 17050
2
SCHEDULE J
BENEFICIARIES
(Part I, Taxable Distributions)
ESTATE OF:
Thelma S. Grove 10/30/2007 203-10-2624
w w
Number Receiving Property Relationship (Words) ($$$)
11 Suzanne Wilt Schmitt Grand Niece specific bequest
105 S. Madison Street
Harrisburg, PA 17109
12 R. Gary Sipe Nephew Thirty percent of rest,
1216 Kings Circle residue and
Mechanicsburg, PA 17050 remainder
13 Ryan T. Sipe Grand Nephew specific bequest
1216 Kings Circle
Mechanicsburg, PA 17050
14 Tyler R. Sipe Grand Nephew specific bequest
1216 Kings Circle
Mechanicsburg, PA 17050
15 Cindy K. Sowers Niece specific bequest
1366 White Oak Tree Road
Gardners, PA 17324
16 Lucille Sipe Wilt Niece Ten percent of rest,
410 Third Street residue and
New Cumberland, PA 17070 remainder & specific
bequest
3
Item Namo and Addross of Person(s)
Share of Estate
Amount of Estate
SCHEDULE J.IIB
CHARITABLE AND GOVERNMENTAL
DISTRIBUTIONS
continued
Rev-1502 EX+ (6-98)
COMMON\lVEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Grove, Thelma S.
IFILE NUMBER
21-07-1012
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Bethany Village - 325 Wesley Drive, Mechanicsburg, PA 17055 - specific bequest of
sewing machine
20.00
2
St. Johns Franklin Lutheran Church - P.O. Box 21, Dillsburg, PA 17109 - specific
bequest
5.000.00
3
United Methodist Stewardship Foundation Charitable Gift Annuity -100% to United
Methodist Stewardship Foundation of Central Pennsylvania, 303 Mulberry Drive,
Suite 300, Mechanicsburg, PA 17050, to be placed in Glenn B. and Thelma S. Grove
Memorial Fund for the benefit of the Shiremanstown United Methodist Church
213.593.23
Subtotal
218.613.23
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule J-IIB (Rev. 6-98)
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LAST WILL AND TESTAMENT
OF
THELMA S. GROVE
I, THELMA S. GROVE, of Mechanicsburg, Cumberland
County, Pennsylvania, make, publish and declare this as and for
my Last Will and Testament, hereby revoking all other WiLls and
Codicils heretofore made by me.
FIRST: I give and bequeath the sum of Five Thousand and
No/100 ($5,000.00) Dollars to the FRANKLIN LUTHERAN CHURCH, the
church of my late husband, GLENN B. GROVE, of Franklin Church
Road, Dillsburg, Pennsylvania, to be used for general church
purposes as deemed appropriate by the FRANKLIN LUTHERAN CHURCH.
SECOND: I give and bequeath to my niece, LUCILLE SIPE
WILT, of 410 Third Street, New Cumberland, Pennsylvania, the
hutch located in the second bedroom provided, however, that
should she predecease me, I direct that the bequest specifically
set forth under this Clause be and become a part of my residuary
estate to be distributed as set forth in Clause SEVENTEEl'JCrH
hereinbelow.
THIRD: I give and bequeath to BETTY GROVE McCl\.uSLIN,
of 181 Dug Hill Road, Biglerville, Pennsylvania, the Corner
Cupboard (including all dishes and knickknacks normally located
therein and thereon), the davenport and love seat, glider rocker,
bedroom suit and chest of drawers (including anything located
therein except, however, any jewelry, which is not included in
this bequest), provided, however, that should she predecease me,
then to my niece, KATHY J. McCAUSLIN, of 124 Robson Road,
Dillsburg, Pennsylvania.
FOURTH: I give and bequeath to ERIC G. GROVE, of 7
Maple Place, Andover, New Jersey, the nephew of my deceas:ed
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husband, GLENN B. GROVE, the American Flag and case that vvas
placed on my deceased husband's casket, provided, however, that
should he predecease me, then to DALE R. GROVE, brother of my
deceased husband, GLENN B. GROVE, of 237 Hickory Road,
Littlestown, Pennsylvania.
FIFTH: I give and bequeath to my niece, CINDY K.
SOWERS, of 1366 White Oak Tree Road, Gardners, Pennsylvania, the
small black stand and mirror, provided, however, that should she
predecease me, I direct that the bequest specifically set forth
under this Clause be and become a part of my residuary estate to
be distributed as set forth in Clause SEVENTEENTH hereinbelow.
SIXTH:
I give and bequeath to my great-niece, SUZANNE
"
WILT SCHMITT, of 105 S. Madison Street, Harrisburg, Pennsylvania,
my white crochet afghan with pink roses, provided, however, that
should she predecease me, I direct that the bequest specifically
set forth under this Clause be and become a part of my residuary
estate to be distributed as set forth in Clause SEVENTEENTH
hereinbelow.
SEVENTH:
I give and bequeath to my great-niece, JoANN
WILT LOWER, of 1365 Old Quaker Road, Etters, Pennsylvania, my
crochet log cabin afghan, provided, however, that should she
predecease me, I direct that the bequest specifically set forth
under this Clause be and become a part of my residuary estate to
be distributed as set forth in Clause SEVENTEENTH hereinbelow.
EIGHTH: I give and bequeath to my nephew, DANIEL
EDWARD GROVE, of 401 North 5th Street, Lemoyne, Pennsylvania, the
Grove Farm picture, provided, however, that should he predecease
me, I direct that the bequest specifically set forth under this
Clause be and become a part of my residuary estate to be distrib-
uted as set forth in Clause SEVENTEENTH hereinbelow.
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NINTH: I glve and bequeath to BETHANY VILLAGE, of 325
Wesley Drive, Mechanicsburg, Pennsylvania, my sewing machine,
with specific direction that it be used In the Craft Program.
TENTH: I give and bequeath to DALE R. GROVE, my de-
ceased husband's brother, of 237 Hickory Road, Littlesto\~n,
Pennsylvania, the end table and light, silverware, black antique
chair, glass candle holders, small clock on shelf and wooden set
of buildings (located on the corner cupboard), provided, however,
that should he predecease me, I direct that the bequest specifi-
cally set forth under this Clause be and become a part 0:: my
residuary estate to be distributed as set forth in Clause
SEVENTEENTH hereinbelow.
ELEVENTH: I give and bequeath to my nlece, JOYCE SOWERS
IRVIN, of 86 White Oak Tree Road, York Springs, Pennsylvania, my
jewelry, diamond watch, diamond ring, wedding ring (all being
located in the dresser in my bedroom) and the cedar chest (lo-
cated in the second bedroom), provided, however, that should she
predecease me, then to my niece, PENNY SOWERS DAVIS, of :~:2 8 N.
Main Street, York Springs, Pennsylvania.
TWELFTH: I give and bequeath to RYAN T. SIPE and TYLER
R. SIPE, the children of KIMBERLY J. ANSERSON SIPE and R. GARY
SIPE, or the survivor thereof, of 1216 Kings Circle,
lo'Iechanicsburg, Pennsylvania, the curio, the HUr.'mel Collection and
all other pieces which accompany that collection.
THIRTEENTH: I give and bequeath to my niece, PENNY
SOWERS DI".VIS, of 228 N. Main Street, York Springs, Pennsylvania,
the dining room table and four (4) chairs, provided, however,
that should she predecease me, I direct that the bequest ~3pecifi-
cally set forth under this Clause be and become a part of my
residuary estate to be distributed as set forth in Clause
SEVENTEENTH hereinbelow.
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FOURTEENTH: Any and all personal property, furniture,
contents and the like owned by me at the time of my death and not
specifically set forth in this, my Last Will and Testament, shall
be and become a part of my residuary estate to be distributed as
set forth in Clause SEVENTEENTH hereinbelow.
FIFTEENTH: I give and bequeath the sum of Five Thou-
sand and No/100 ($5,000.00) Dollars to my friend, JOETTE GIBSON,
of 503 Katrina Court, Mechanicsburg, Pennsylvania, provided,
however, that should she predecease me, I direct that the bequest
specifically set forth under this Clause be and become a part of
my residuary estate to be distributed as set forth in Clause
SEVENTEENTH hereinbelow.
SIXTEENTH: I give and bequeath the sum of Five Thou-
sand and No/100 ($5,000.00) Dollars to my niece, MARLENE SIPE
DAUGHERTY, of 910 Sterling Court, Enola, Pennsylvania, provided,
however, that should she predecease me, I direct that the bequest
specifically set forth under this Clause be and become a part of
my residuary estate to be distributed as set forth in Clause
SEVENTEENTH hereinbelow.
SEVENTEENTH: I devise and bequeath all the rest,
residue and remainder of my estate of whatever nature and
wherever situate, including any property over which I hold power
of appointment and together with any insurance policies thereon,
as follows:
(A) Thirty (30%) percent thereof to my nephew, R. GARY
SIPE, provided, however, that should he predecease me, then to
his wife, KIMBERLY J. ANDERSON SIPE. In the further event that
both R. GARY SIPE and KIMBERLY J. .~DERSON SIPE predecease me, I
give and bequeath said share, in equal shares, to RYAN T. SIPE
and TYLER R. SIPE, the children of R. GARY SIPE and KIMBERLY J.
ANDERSON SIPE.
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(B) Thirty (30%) percent thereto to KIMBERLY J.
ANDERSON SIPE, provided, however, that should she predec'2ase me,
then to R. GARY SIPE.
In the further event that both KIMBERLY J.
ANDERSON SIPE and R. GARY SIPE predecease me, I give and bequeath
said share, in equal shares, to RYAN T. SIPE and TYLER R. SIPE,
the children of KIMBERLY J. ANDERSON SIPE and R. GARY SIPE.
(C) Ten (10%) percent to LUCILLE SIPE WILT, provided,
however, that should she predecease me, then to her issue per
stirpes, by representation.
(D) Fifteen (15%) percent to DALE R. GROVE, provided,
however, that should he predecease me, then to his issue per
stirpes, by representation.
(E) Fifteen (15%) percent to BETTY GROVE McCAUSLIN,
provided, however, that should she predecease me, then to her
lssue per stirpes, by representation.
EIGHTEENTH:
Should either RYAN T. SIPE or TYLER R.
SIPE, not have attained the age of twenty-five (25) years at the
time for distribution to them, I give, devise and bequeath their
share to my hereinafter named Trustee or Trustees, IN SEPARATE
TRUSTS, to hold, manage, invest and reinvest the shares so
received, and to use and apply from time to time such portion of
income and principal for their post-high school education (in-
cluding college, trade school or other similar training or
education), as my Trustee or Trustees, In their sole discretion,
deem advisable. The Trustee or Trustees, in exercising their
discretionary authority with respect to the payment of income or
principal of the within Trust to either RYAN T. SIPE or TYLER R.
SIPE, shall take into consideration any income or other resources
available to them from sources outside this Trust.
Any income or principal not so applied shall be dis-
tributed to either RYAN T. SIPE or TYLER R. SIPE when they attain
the age of twenty-five (25) years. In the event either RYAN T.
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SIPE or TYLER R. SIPE die prior to the termination of the Trust
established herein for their benefit, the interest of either RYAN
T. SIPE or TYLER R. SIPE in said Trust shall cease with any
income and principal passing to the survivor as between the two
of them or the separate trust established hereunder for that
survivor's benefit.
NINETEENTH: In addition to all powers granted to them
by law and by other provisions of this Will, I give the fiducia-
ries acting hereunder the following powers, applicable to all
property, exercisable without court approval and effective until
actual distribution of all property:
(A) To sell at public or private sale, or to lease,
for any period of time, any real or personal property and to give
options for sales, exchanges or leases, for such prices and upon
such terms (including credit, with or without security) or
conditions as are deemed proper. This includes the power to glve
legally sufficient instruments for transfer of the property and
to receive the proceeds of any disposition of it.
(B) To partition, subdivide, or improve real estate
and to enter into agreements concerning the partition, subdivi-
sion, improvement, zoning or management of real estate and to
lmpose or extinguish restrictions on real estate.
(e) To compromise any claim or controversy and to
abandon any property which is of little or no value.
(D) To invest in all forms of property, including
stocks, common trust funds and mortgage investment funds, without
restriction to investments authorized for Pennsylvania fiduci-
aries, as are deemed proper, without regard to any principle of
diversification, risk or productivity.
(E) To exercise any option, right or privilege granted
in insurance policies or in other investments.
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(F) To exercise any election or privilege given by the
Federal and other tax laws, including, but not necessarily being
limited to, personal income, gift and estate or inheritance tax
laws.
(G) To make distributions to my herein named benefici-
aries In cash or in kind or partly in each.
(H) To borrow money from themselves or others in order
to pay debts, taxes, or estate or trust administration expenses,
to protect or improve any property held under my will, and for
investment purposes.
(I) To select a mode of payment under any qualified
retirement plan (pension plan, profit sharing plan, employee
stock ownership plan, or any other type of qualified plan) to the
extent the plan or the law permits them to do so, and to exercise
any other rights which they may have under the plan, in whatever
manner they consider advisable.
TWENTIETH:
I nominate and appoint JEFFREY J. ;~NDERSON,
of 6111 Glatfelters Station Road, Seven Valleys, Pennsyl'Jania, as
Trustee of the hereinabove described trusts.
In the event of the
death, resignation or inability to serve for any reason whatso-
ever of the said JEFFREY J. ANDERSON, I nominate and appoint,
TIMOTHY C. BARRETT, of 253 Noah Drive, Franklin, Tennessee, as
Trustee of the hereinabove described trusts. I direct that my
Trustee or Trustees shall serve without bond and shall receive
fair and reasonable compensation.
TWENTY-FIRST:
I direct that all inheritance, estate,
transfer, succession and death taxes, of any kind whatsoever,
which may be payable by reason of my death, whether or not with
respect to property passing under this Will, shall be paid out of
the principal of my residuary estate.
7
-- . - .....
TWENTY-SECOND: All interests hereunder, whethe:c
principal or income, which are undistributed and in the posses-
sion of the fiduciaries acting hereunder, even though vesced or
distributable, shall not be subject to attachment, execution or
sequestration for any debt, contract, obligation or liability of
any beneficiary, and furthermore, shall not be subject to pledge,
assignment, conveyance or anticipation.
TWENTY-THIRD:
I nominate and appoint R. GARY SIPE,
Executor of this, my Last Will and Testament.
In the eve::} t 0 f
the death, resignation or inability to serve for any reason
whatsoever of the said R. GARY SIPE, I nominate and appoint
KIMBERLY J. ANDERSON SIPE, Executrix of this, my Last Will and
Testament.
I direct that my Executor or Executrix, my T:custee or
Trustees, and their successors, shall not be required to post
security or a bond for the performance of their duties in any
jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and
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seal to this, my Last Will and Testament, this ,~I A day of
!.l " ,/ 2005
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(SEAL)
THELMA S. GROVE
8
Signed, sealed, published and declared by the above-
named Testatrix as and for her Last Will and Testament in our
presence, who, at her request, in her presence and in the
presence of each other, have hereunto subscribed our names as
attesting witneSses.
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9