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Home My WebLink About03-0746Estate of Mary M. also known as Register of Wills of Cumberland PETITION FOR GRANT OF Grove , Deceased John C. Grove Petitioner(s),whois/are18yearsofageorolder, apply(ies)for: County, Pennsylvania LETTERS Social Security No. 203 - 10- 7466 (COMPLETE 'A' or 'B' BELOW:) A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut or the Decedent, dated 12/11/1975 and codicil(s) dated None named in the last Will of State relevant circumstances, e.g., renunciation, death of executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: B. Grant of Letters of Administration (c.t.a.; d.b.n.c.ta; pendente lite; durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: I Name Relationship Residence (COMPLP_. I h IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania with his/her last family or principal residence at 325 Wesley Drive, Lower Decedent, then 84 years of age, died 08/31/2003 Allen Twp., Mechanicsbur~, PA 17055 (liststreet, number, and municipality) at Sara Todd Nursing Home, Carlisle, PA (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled in PA) Personal property in Pennsylvania (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania 13,000.00 situated as follows: Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: Signature Typed or printed name and residence ~ John C. Grove · 12 N. Church Street, Mohnton, PA 19540 Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form RW-1 (1991) Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed ~(~_~. ~.~. ~ rove before rne this '1 '1 'l-}~lay of .~tember , 200__3 For the Register Donna M. Otto, 1st Deputy No. Estate of Mary M. Grove Social Security No: 203-10- 7466 AND NOW, September llth 21-2003-746 Date of Death: 08/31/2003 ,2003 of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters ~-~ Testamentary [~ Of Administration Dec~sed , in consideration-- (c.t.a.; d.b.n.c.t.a.; pendente lite; durante ab,~tia; durante minoritate) are hereby granted to John C. Grove in the above estate and that the instrument(s) dated 12/11/1975 Letters ........... $ 50. O0 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. 9.00 Do na M.Otto . Attorney: Short Certificate(s) ..... $ Renunciation ........ $ Affidavits ( ) .... $ Extra Pages ( ) .... $ Codicil ........... $ JCP Fee .......... $ Inventory .......... $ James G. Morgan, Jr. 3.00 10.00 I.D. No: 06897 Tucker Arensberg, P.C. Address: 111 North Front Street P.O. Box 889 Harrisburg, PA 17108-0889 Telephone: 717/234-4121 Other ........... $ TOTAL ......... $ Prepared by the Pennsylvania Bar Association Letters will be 72.00 Copyright (c) 1996 form software only CPSystems, Inc. pick up today 9/11/03 Form RW-1 (1991) Estate of also known as Register of Wills of Cumber].and County, Pennsylvania OATH OF SUBSCRIBING WITNESS Mary M. Grove No. 21-2003-746 , Deceased Lee C. Swartz Pamela Gordon (each) a subscribing witness to the [---] codicil(s) I-~ will(s) presented herewith, (each) being duly qualified according to law depose(s) and say(s) that she/he/they was/were present and saw the above Testator(rix) sign the same and that she/he/they signed as a witness at the request of Testator(rix) in his/her/their presence and l-~ in the presence of each other ~ in the presence of the other subscribing witness(es). (Signature) (Address) (Signature')-"/--Lee 'C. Swa~tj 111 North Front S~ree~ I~arrisburs, PA Pamela Gordoh - 111 North Front Street Harrisburg, PA 17101 Sworn to or affirmed and subscribed before me this day of Notary Public My Commission Expires: (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's commission.) NOTE: To be taken by officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization. Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form #RW-Z (1991) 105.805 P~EV 9/86 This is to certify that the information here given is correctly copied from an original certificate of death d~ly filed with me as Local.Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent ~[ing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 No. Local ~egistrar- 'M. Grove 84 ~'.. i I Nov 25. 191~ Cumberland Cadisle Homemaker Own Home 325 Wesley Ddve csburg, Pennsylvania 1701 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH - VITAL RECORDS CERTIFICATE OF DEATH ~. Female :k 203- 10- Carlisle, Pennsylvan ~ [] .me.~,~ [] o~. [] ~ [~ "~.,~,~ ~ is.~:~ L~ Sara Todd Nursing Home .?_ E:k v~ [] ,~. ~.~, e~. '"""' ~'~" ""="""~' White · ..[] ..Ek ~,~ (,~.~+, Widowed ,,..s=, . Pennsy vania ~ ,~.l~k-~.,~.~m~.,~. I nw~r Allen Twn ,v~. c~,~ Cumberland ~"~' ,,~E] .~"~ John Flickinger Patricia M. Grove Sep 5,2003 7466 Lillian Stoner 1 Grandview Court Mechanicsburg, Pa. 17055 Mechanicsburg Cemetery I Mechanicsburg Pennsylvania Mechanicsburc · I&t ,,,,~ t¢J V E1 21-2003-746 WILL I, MARY M. GROVE, of the Borough of Mechanicsburg, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my Last Will and Testament, hereby revoking and making void any and all Wills, Codicils and other testamentary documents by me at any time heretofore made. ITEM I. I direct that all my just debts and funeral expenses be paid from the assets of my estate as soon as practic- able after my decease as a part of the expenses of the administra- tion of my estate. ITEM II. I direct that any and all inheritance, estate, succession and other death taxes of whatever nature and by whatever jurisdiction imposed, assessed against my estate or payable by reason of my death, shall be paid as soon as practic- able after my decease as a part of the expenses of the admini~ tion of my estate. ITEM III. I give, devise and bequeath all the rest, residue and remainder of my estate of every nature and wherever situate to my husband, CHARLES A. GROVE, if he survives me by sixty (60) days. If he does not survive me by sixty (60) days, I give, devise and bequeath all the rest, residue and remainder of my estate of every nature and wherever situate in equal shares to my children. ITEM IV. I hereby nominate, constitute~and appoint my son, JOHN C. GROVE, to be the Executor of this my Last Will and Testament. Page 1 of 2 pages. Mary W. Grove (SEAL ITEM V. I direct that my personal representative shall not be required to give bond for the faithful performance of his duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament, consisting of this and one other page, at the end of which I have also set my hand and seal for greater security and better identification, this //4 ~ay of December, 1975. Mary ~. Grove WE, the undersigned, hereby certify that the foregoing Will was 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 and in her presence and in the presence of each other, have hereunto set our hands and seals the day and year above written, and we certify that at the time of execution thereof, the Testatrix was of sound and disposing mind and memory. WILL LEE C. SWARTZ, ESQUIRE LAW OFFICES HEPFORD, ZIMMERMAN & SWARTZ P. O. l~OX 889 !1! NORTH FRONT STREET HARRISBURG, PENNSYLVANIA 17108 CERTIFICATION OF NOTICE UNDER RULF: 5.6(a) BEFORE THE In re: ESTATE OF MARY M. GROVE, Deceased. DATE OF DEATH: August 31, 2003 Will No. 2003-00746 To the Register: REGISTER OF WILLS, CUMBERLAND COUNTY OF PENNSYLVANIA Administration No. I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court rules was served on or mailed to the following beneficiaries of the above-captioned estate on October 29, 2003: Name Address John C. Grove William A. Grove Ricahrd L. Grove Susan D. Bowers Patrice E. Miller Catherine A. Thomas 12 North Church Street, Mohnton, PA 19540 7771 Highway X, Three Lakes, WI 54562 2238 Preservation Court, Su City Center, FL 33573 711 Ridge Road, Lewisberry, PA 17339 1 Grandview Court, Mechanicsburg, PA 17055 6 Edgewood Drive, Mechanicsburg, PA 17055 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: Date: Signature: Name: Address: Capacity: Telephone: X "James G. Morl~n,,/Jr.~, Tucker Arens~)erg, P.C'~. 111 North Front Street P.O. Box 889 Harrisburg, PA 17108-0889 717/234-4121 Personal Representative ~ Counsel for Personal Representative TUCKER ARENSBERG Attorneys November 24, 2003 Cumberland County Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Re: Estate of Mary M. Grove Will No. 2003-00746 Dear Sir or Madam: I am enclosing herewith a check in the amount of $450.00 representing the 5% discount prepayment of estimated Pennsylvania inheritance tax relative to the above estate. Should you have any questions, please do not hesitate to contact me. Sincerely, Tucker Arensberg, P.C. Theresa A. Wheeler Legal Assistant to James G. Morgan, Jr. :taw Enclosures Tucker Arensberg, RC. 111 North Front Street P.O. Box 889 Harrisburg, PA 17108 www. tuckerlaw, com p. 800.257.4121 p. 717.234.4121 f. 717.232.6802 TUCKER ARENSBERG Attorneys 111 North Front Street P.O. Box 889 Harrisburg, PA 17108 Cumberland County Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 tTO t3~330 t i,,,lll,,,lll,,,,,,ih,lh,,li,,,Ihll,,,,,,llt,I, COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD REV-1162 EX(11-96) 003279 MORGAN JAMES G JR 111 N FRONT ST P O BOX 889 HARRISBURG, PA 17108-0889 ........ fold ESTATE INFORMATION: SSN: 203-10-7466 FILE NUMBER: 2103-0746 DECEDENT NAME: GROVE MARY M DATE OF PAYMENT: 11/25/2003 POSTMARK DATE: 11/24/2003 COUNTY: CUMBERLAND DATE OF DEATH: 08/31/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $450.00 TOTAL AMOUNT PAID: 9450.00 REMARKS' JAMES MORGAN ESQUIRE SEAL CHECK# 1002 INITIALS: VZ RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS REV- 1500 EX + (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. Z80601 HARRISBURG, PA 171Z8-0601 D E C E D E REV-1500 NHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Grove Mary M. DATE OF DEATH (MM-DD-YEAR) 08/31/2003 N T DATE OF BIRTH (MM-DD-YEAR) 11/25/1918 CAPB HpRL EpIO cRAC KO[~ (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) R E C A P I T U L A T I O N T C O M T I 0 1. Original Return ~ 2. Supplemental Return 4. Limited Estate 4a. Future Interest Compromise (date of death after 1Z- 1Z-8Z) 6. Decedent Died Testate 7. Decedent Maintained a Living Trust (Attach copy of Will) (Attach copy of Trust) [~9. Litigation Proceeds Received I I Spousal Poverty 10. Credit (date of death between 1;)-31-91 and 1 -1-95) NAME James G. Morgan Jr., Esquire FIRM NAME (If Applicable) Tucker Arensber~, P.C. TELEPHONE NUMBER 717/234-4121 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or (3) Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) ~ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 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) 12. Net Value of Estate (Line 8 minus Line 11 ) 13. 14. OFFICIAL USE ONLY FILE NUMBER 2003-00746 COUNTYCODE YEAR NUMBER SOCIAL SECURITY NUMBER 203-10-7466 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER (date of death 3. Remainder Return prior to 12-13-8:>) 5. Federal EstateTax Return Required 8. Total Number of Safe Deposit Boxes Election to tax under Sec. 9113(A) 1 1. (Attach ScL O) COMPLETE MAILING ADDRESS 111 North Front Street P.O. Box 889 Harrisburg, PA 17108-0889 None None None None 23,887.75 None None 13,766.17 None OFFICIAL USE ONLY (8) 23,887.75 (11) 13,766.17 (12) 10,121.58 Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13). made/Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) (14) X .0 0 X .0 45 X .12 X .15 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 10,121.58 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due (15) 0.00 (15) 455.47 (17) 0.00 (18/ o.oo (19) 455.47 10,121.58 Copyright (c) :>000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 325 Wesley Drive CITY Mechanicsbur~ STATE ?A Tax Payments and Credits: 1. Tax Due/Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 450.00 22.77 ZIP 17055 Total Credits ( A + B + C ) (2) (1) 455.47 472.77 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 17.30 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE BUE. (5B) 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No ;. retain the use or incorne of the property transferred; ......................... ~] ~ · 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? ................................ [--'] ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............................................. r'-] ~m 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property a beneficiary designation? ................................ [-m ~] which contains 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 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 preparer has any knowledge, SIGNATUREOF PERSON RESPONSIBLE FOR FILING RETURN John C Grove DATE.:' ," ............................... ~ % ' . ' ~/~A Mohnton, PA 19540 J~E~"~RE~AREROTHERT~EPRESENTATIVE Tucker Arensber=, P C DA~ .... /-"~ .~'L ~. /~ 111 North Front Street . '~,'~,~ , - ....... ~ ............................................ : (' ......... ~:r~/~'"f r~//'/ Harrisburg, PA 17108-0889 For d~fi/6f doath on or a~,r ~:1~ 10~4 and b~or~ 3anua~ 1, 1005, th~ tax rat, imposod on th~ n~t valu, of transfors to or for th~ us~ of th~ surv~ spous~ is 3% [72 ?.S. Ollfi (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 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 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)]. 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 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) REV- 1508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary M. Grove SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER SS# 203-10-7466 08/31/2003 2003-00746 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH Miscellaneous cash Miscellaneous cash Bethany Towers - security deposit return M&T Bank - checking account #38913372 Accrued interest on item 4 to date of death M&T Bank - Certificate of Deposit #31003914667381 Accrued interest on item 5 to date of death MetLife - reimbursement for renter's and health insurance 216.55 204.45 55.00 3,158.94 0.08 19,761.41 138.22 353.10 TOTAL (Also enter on line 5, Recapitulation) $ 23,887.75 (if more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97) REV-1511 EX, (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary M. Grove SS~ 203-10-7466 SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS 08/31/2003 FILE NUMBER 2003-00746 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT Ao 2 3 4 5 6 FUNERAL EXPENSES: Myers Funeral Home, Inc. funeral fees ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: Attorney's Fees Tucker Arensberg, P.C. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent Probate Fees Register of Wills Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Bethany Towers final rent payment Cumberland County Law Journal Gingrich Memorials - tombstone M&T Bank - estate checks Sarah Todd Nursing Home - nursing Sprint telephone bill proof of publication inscription home care 7,020.40 1,700.00 72.00 89.00 75.00 95.00 16.75 4,256.98 73.19 Total of Continuation Schedule(s) 367.85 TOTAL(Alsoenteronline9, Recapitulation) $ 13,766.17 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97) REV-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary M. Grove SS~/ 203-10-7466 SCHEDULE J BENEFICIARIES 08/31/2003 FILENUMBER 2003-00746 NUMBER II. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116~(1.Z)] Susan D. Bowers 711 Ridge Rd. Lewisberry, PA 17339 John C. Grove 12 North Church Street Mohnton, PA 19540 Richard L. Grove 2238 Preservation Green Ct. Sun City Center, FL 33573 William A. Grove 7771 Highway X Three Lakes, WI 54562 Patrice Grove Miller 1 Grandview Court RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Daughter Son Son Son Daughter AMOUNT OR SHARE OF ESTATE 1/6 residue of estate 1/6 residue of estate 1/6 residue of estate 1/6 residue of estate 1/6 residue of estate ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET 0 o 00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 2:000 form software only The Lackner Group, Inc. Form REV- 1513 EX (Rev. 9-00) Estate of: Mary M. Grove Soc Sec #: 203-10-7466 Date of Death: 08/31/2003 Item Description Continuation of Schedule H-B2 (Attorney's Fees) Amount Tucker Arensberg, P.C. Attorney fees 1,700.00 1,700.00 Estate of: Mary M. Grove Soc Sec #: 203-10-7466 Date of Death: 08/31/2003 Item Description Continuation of Schedule H-B4 (Probate Fees) Amount Register of Wills - probate fees 72.00 72.00 Estate of: Mary M. Grove Soc Sec #: 203-10-7466 Date of Death: 08/31/2003 Item Description Continuation of Schedule H-B7 (Other Administrative Costs) Amount St. Paul's UCC - after funeral refreshments The Sentinel Proof of Publication] West Shore EMS transportation to dr. appt. 183.14 102.11 82.60 367.85 Estate of: Mary M. Grove Soc Sec #: 203-10-7466 Date of Death: 08/31/2003 Continuation of Schedule J, Part I (Taxable Bequests) Item Name and Address of Beneficiary Relationship Amount or Share of Estate Mechanicsburg, PA 17055 Catherine A. Thomas 6 Edgewood Drive Mechanicsburg, PA 17055 Daughter 1/6 residue of estate Register of Wills of CUMBERLAND INVENTORY County, Pennsylvania Estate of Mary M. Grove also known as , Deceased No. 2003-00746 Date of Death 08/31/2003 Social Security No. 203 - 10- 7466 John C. Grove, Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/VVe verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Personal Representative Name of ~C .~Gr~gve~-~ Attorney: James G. Morgan Jr., Esquire Signature: I.D. No.: 06897 Signature: Address: lll North Front Street Address: 12 N. Church St. Harrisburg, PA 17108-0889 Mohnton, PA 19540 Telephone: 717/234-4121 Telephone: 610/777-2786 (See continuation page(s) (Attach additional sheets if necessary) Description attached) Value Total: 37,029.42 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. Prepared by the Pennsylvania Bar Association Copyright (c) 1996 form software only CPSystems, Inc. Form #RW-7 (199Z) Estate of: Date of Death: County: Mary M. Grove o8/31/2oo3 Cumberland INVENTORY CASH: Bethany Towers - security deposit return M&T Bank - checking account #38913372 Accrued interest through date of death M&T Bank - Certificate of Deposit #31003914667381 Accrued interest through date of death MetLife - reimbursement for renter's and health insurance MetLife Insurance Company - Life Insurance policy no. 591 236 449 MP MetLife Insurance Company - Life Insurance policy no. 935 500 635 M Miscellaneous cash Miscellaneous cash 55.00 3,158.94 0.08 19,761.41 138.22 353.10 2,790.76 10,350.91 216.55 204.45 37,029.42 -1- BUREAU OF ZNDZVTDUAL TAXES TNHER/TANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 CONNONWEALTH OF PENNSYLVANIA DEPARTNENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLO#ANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-15~i? EX AFP C01-03) JANES G HORGAN JR ESQ TUCKER ETAL PO BOX 889 DATE 02-16-200q ESTATE OF GROVE DATE OF DEATH 08-$1-2005 FILE NUMBER Z! 05-07q6 ~cOUNTY CUMBERLAND AGN ~ 0 ~ MARY M PA 171~mbetiand Co., PA Aaount Remitted L HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUMBERLAND C0 COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE I~ RETAIN LOWER PORTION FOR YOUR RECORDS *'~ REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRA/SEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF GROVE NARY NFZLE NO. 21 05-07q6 ACN 101 DATE 02-16-200~ TAX RETURN WAS: (X) ACCEPTED AS F/LED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: 1. Real Estate (Schedule A) 2. $. q. .6. 6. 7. 8. ORIGINAL RETURN (1) Stocks and Bonds (Schedule B) (2) Closely Held Stock/Partnership Interest (Schedule C) (S) Nortgages/Notes Receivable (Schedule D) (~) Cash/Bank Deposits/Misc. Personal Property (Schedule E) ($) Jointly Owned Property (Schedule F) (6) Transfers (Schedule G) (7) Tote1 Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expanses/Ada. Costs/Misc. Expanses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deduct ions 12. Net Value of Tax Return 15. lq. (9) (10) Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) Nat Value of Estate Sub~ect to Tax O0 25/887.75 O0 O0 O0 NOTE: To insure proper O0 credit to your account, 00 subait the upper port/on of this form with your tax payment. (8) 15,766.17 .00 25,887.75 (11) 13.7~6.17 (12) 10,121.58 (15) .00 (lq) 10,121.58 NOTE: Z~ an assessment was issued prev/ously, lines 14, 15 and/or 16, 17, 18 and 19 w111 reflect flgures that /nclude the tota! of ALL returns assessed to date. ASSESSHENT OF TAX: 15. Amount of Line lq at Spousal rata (1E) . O0 X O0 = 16. Amount of Line lfi taxable at Lineal/Class A rata (16) 10,121.58 X Oq5 = 17. Amount of Line lq at Sibling rata (17) .00 X 12 = 18. Amount of Line lq taxable at Collateral/Class B rata (18) .00 x 15 : 19. Principal Tax Due (19)= .O0 q55.q7 .00 .00 q55.q7 TAX CREDITS: PAYMENT BATE Il-Iq-Z005 02-09-200~ RECEIPT NUMBER CD005279 REFUND ZF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. DISCOUNT INTEREST/PEN PAID (-) 22.77 .00 AMOUNT PAID q50.00 17.30- TOTAL TAX CREDIT I q55.q7 BALANCE OF TAX DUEl .00 INTEREST AND PEN. . 00 TOTAL DUE .00 ( ZF TOTAL DUE ZS LESS THAN $1~ NO PAYMENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT' (CR)~ YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTZONS.)__,,_~-~ RESERVATION: PURPOSE OF NOTICE: PAYNENT: REFUND (CR): OBJECTIONS: ADNIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 12) 1982 -- if any future interest in the estate is transferred Jn possassion or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years) the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class D (collateral) rate on any such future interest. To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (72 P.S. Section 91~0). Detach the top portion of this Notice and submit with your payment to the Register of Nills printad on the reverse side. --Hake check or money order payable to: REGISTER OF #ILLS, AGENT A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS15). Applications are available at the Office of the Register of Hills, any of the 23 Revenue District Offices, or by calling the special Z4-hour answering service for fores ordering: 1-800-362-2050; sarvicas for taxpayers with special hearing and / or speaking needs: 1-800-~47-3020 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Not/ca must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appaal ta the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue) Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions far Inheritance Tax Return for a Resident Decedent" (REV-iS01) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (52) discount of the tax paid is allowed. The 152 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, tha first day after the end of the tax amnesty period. This non-participation penalty is appealable in the soma manner and in the the same tima period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear intarest at the rate of six (62) percent per annum calculated at a daily rate of .000164. All taxes which became dalinquant on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. Tha applicable interest rates for 1982 through ZOOS are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 1982 202 .0005~8 1987 92 .000247 1999 72 .000192 1983 162 .000438 1988-1991 llZ .000301 2000 82 .000219 1984 112 .000301 1992 92 .000247 2001 92 .000247 1985 132 .000356 1993-199~ 72 .O00lgz 200Z 62 .000164 1986 iOZ .000274 1995-1998 92 .0002~7 2003 52 .000137 --Interest is calculated as follows: INTEREST = BALANCE 0£ TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issuad after tha tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. Xf payment is made after the interest computation date shown on the Notice, additional interest must be calculated. TOTAL RECEIPTS OF PRINCIPAL ............... 37,029.42 -2- BUREAU OF ZNDTVZDUAL TAXES I'HHERZTANCE TAX DZVTSTON DEPT. ;'806O1 HARR*rSBURG, PA 171Z8-0601 COMMONNEALTH OF PENNSYLVANZA DEPARTHENT OF REVENUE ZNHERZTANCE TAX STATEMENT OF ACCOUNT RE¥-16D7 EX &FP (01-D5) '04 JAMES G HORGAN JR ESQ TUCKER ETAL PO BOX 889 ~ HBG PA t7i08 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN OZ-Z$-ZOOq GROVE 08-51-2005 21 05-07q6 CUMBERLAND 101 Amount: Rem i'l:'l:ed MARY M HAKE CHECK PAYABLE AND REMZT PAYHENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credi~ ~o your account, submi~ ~he upper portion of ~:his form ~i~:h your ~:ex payment. CUT ALONG TH'rS L'rNE ~ RETAIN LONER PORTION FOR YOUR RECORDS -,~ REV-1607 EX AFP (01-03) ### ZNHERZTANCE TAX STATEMENT OF ACCOUNT ESTATE OF GROVE MARY M FZLE ND. Z1 05-07~6 ACN 101 DATE 0Z-25-200~ THTS STATEMENT TS PROVIDED TO ADV/SE OF THE CURRENT STATUS OF THE STATED ACN TN THE NAMED ESTATE. SHONN BELO# TS A SUMMARY OF THE PRZNC'rPAL TAX DUE, APpLTCAT'rON OF ALL PAYMENTS, THE CURRENT BALANCE, AND, TF APpLTCABLE, A PROJECTED /NTEREST FTGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: OZ-16-ZO0~ PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYHENTS (TAX CREDITS): q55.q7 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 11-2q-2005 02-09-200q CD005279 REFUND ZZ.77 .00 q50.O0 17.50- ZF PAID AFTER TH/S DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( ZF TOTAL DUE IS LESS THAN $1, NO PAYMENT ZS RE~U~RED. IF TOTAL DUE 1S REFLECTED AS A "CREDIT' (CR), TOTAL TAX CREDIT q55.q7 BALANCE OF TAX DUE .00 ZNTEREST AND PEN. .00 TOTAL DUE .00 YOU MAY BE DUE A REFUND. SEE REVERSE STDE OF THIS FORM FOR INSTRUCTIONS. ) PAYNENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- If RESIDENT DECEDENT make check or money order payable to.' REGISTER OF #TLLS, AGENT. -- Zf NON-RESIDENT DECEDENT make check or money order payable to.' COHHONNEALTH OF PENNSYLVANTA. REFUND (CR): A refund of a tax credit, which was not requested on the Tax Rmturn, may be requested by completing an 'Application far Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS13). Applications are available at the Office of the Register of Nills, any of the 13 Revenue District Offices or from the Department's Z~-hour answering service for fores ordering: 1-800-362-Z050; services for taxpayers eith special hearing and / or speaking needs: 1-BOO-~7-30ZO (TT only). REPLY TO: Questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 171Z8-0601, phone [717} 787-6S05. DISCOUNT: If any tax due is paid mithin three (3) calendar months after the decedent's death, a five percent (51) discount of the tax paid is allowed. PENALTY: The 15Z tax amnesty nan-participation penalty is computed on the tatal of the tax and interest assessed, and not paid before January 18, 1996, the first day after the and of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1981 bear interest at the rate of six (61) percent per annum calculated at a daily rate of .00016~. All taxes which became delinquent on and after January I, 1982 mil! bear interest at a rate which will vary from calendar year to calendar year eith that rate announced by the PA Department of Revenue. The appZicabZe interest rates for 1981 through Z003 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198? ZOZ .O005~B 1987 91 .0001~7 1999 ?Z .000191 1983 162 .000~38 1988-1991 llZ .000501 ZOO0 82 .000219 198~ 112 .000301 1991 91 .0002~7 ZOOX 92 .000247 1985 131 .000356 1993-199~ 7Z .000191 ZOOZ 62 .00016~ 1986 IOZ .000174 1995-1998 9Z .0002~7 2003 51 .000137 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NURBER OF DAYS DBLIN~U~-NT X DAILY /NTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (153 days beyond the date of the assessment. If payment is made after the interest computation date sheen on the Notice, additional interest must bm calculated. PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION STATUS REPORT UNDER RULE 6.12 L/~ ~jj/~. Name of Decedent: Mary M. Grove Date of Death: August 31, 2003 Estate No.: 2003 -00746 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: State whether administration of the estate is complete: Yes x No Date: o If the answer is No, state when the personal representative reasonably believes that the administration will be complete: (date) If the answer to No. 1 is yes, state the following: A. Did the personal representative file a final account with the court? Yes No x B. The separate Orphans' Court No. (if any) for the personal representative's account is: (Not Applicable in Dauphin County) C. Did the personal representative state an account informally to the parties in interest? Yes x No D. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of~ e Orphans' Cou~ and mg~ be attached to this report. //~___.._j///~~, . G. Mo a ,j Jr. S~re James Tucker Arens] P.C. (MAH:rmtJAM3) Name (Please type or print) :"'tit '..~, 1,) P.O. Eox 889 ,.~:~ Harrisburg PA 17108 0889 Capacity: Address (717) 234-4121 Telephone No. Personal Representative X Counsel for Personal Representative ~.W. - 5~