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HomeMy WebLinkAbout10-19-11JERRY R. DUFFLE RICHARD W. STEWART WADE D. MANLEY EDMUND G. MYERS LAW O F F I C E S ELIZABETH D. SNOVER DAVID W. DELUGE ANDREW P. DOLLMAN JOHN A. STATLER ~ T SARAH E. HOFFMAN O~~ ~ TC JEFFERSON J. SHIPMAN O L ~ \~11 J ~ \v' CAROLYN B. MCCLAIN JEFFREY B. RETTIG MARK C. DUFFLE UFFIE OF COUNSEL JOHN R. NINOSKY HORACE A. OHNSON J MICHAEL J, CASS[DY C. ROY WEIDNER, JR. MELISSA PEEL GREEVY CONSTANCE P. BRUNT E LEE SHIPMAN (1965-2006) =1- October 18, 2011 Register of Wills Office Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 RE: Estate of Dorothy E. Groves alk/a Dorothy Groves Date of Death: March 3, 2011 Your File No. 21-2011-0500 Our File No. 15986-1 Dear Register: Enclosed for filing please find the following documents for the above referenced decedent: 1. 2 Original PA Inheritance Tax Returns. There is tax due in the amount of $8,287.79. Estate Check No. 1010 is enclosed. 2. Inventory 3. One copy of Page 1 of the Pa Inheritance tax return to be time-stamped and returned to us. 4. One copy of the Inventory to be time-stamped and returned to us. 5. Our check in the amount of $30.00 representing the filing fee for the Inheritance Tax Return and Inventory. Should you have any questions, please do not hesitate to contact our office. Thank you for you assistance in this matter. c: Karen Headdings, Administratrix :464439 Very truly yours, JOHNSON UFF E,'' SnnT``EnnWART &WEIDNER L~C~~ aria Wieseman Estate Administration Paralegal 301 MARKET STREET P.O. BOX 109 LEMOYNE, PENNSYLVANIA 17043-0109 WWWJDSW.COM 717.761.4540 FAX: 717.761.3015 MAILC~JDSW.COM n t~ ~~ == ^~'1 ~ "" _'V ~7 C~ C'3 i 7 l 1 ~ > ~~n --~ ~ a ~~ `~ __ ~ O~i ` `~ -_ ~ r ~ d ~~~ , {~«. JOHNSON, DUFFIE, STEWART &WEIDNER, P.C. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1712$-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 015080 HEADDINGS KAREN L 44 BANBURY ROAD HUMMELSTOWN, PA 17036 ""---- told ESTATE INFORMATION: SSN: 206-10-8353 FILE NUMBER: 2111-0500 DECEDENT NAME: GROVES DOROTHY E DATE OF PAYMENT: 10/ 19/201 1 POSTMARK DATE: 10/18/201 1 COUNTY: CUMBERLAND DATE OF DEATH: 03/03/201 1 REMARKS: RECEIPT TO ATTY CHECK# 1010 INITIALS: HEA SEAL RECEIVED BY: ACN ASSESSMENT AMOUNT CONTROL NUMBER TOTAL AMOUNT PAID: REV-1162 EX111-961 58,287.79 GLENDA EARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS r ~ INVENTORY REGISTER OF WILLS OF COMMONWEALTH OF PENNSYLVANIA couNTY of Cumberland Karen L Headdings Personal Representative(s) of the Estate o1 deceased, depose(s) and say(s) that the items appearing in the followin invento situate and atl of the real estate in the Commonwealth of Pennsylvania of said Deceldent~that the valuat on placed oppositeveach item of said inventory represents its fair value as of the date of the decedents death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that whic appears in emorandu at the end of this inventory. I verify that the statements made in this Inven- tory are true and correct. I understand that false state- ments herein are made subject to the penalties of ~ Karen L Headdings 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities. Attorney -- (Name) EDMUND G. MYERS (F"'") JOI (Address) 301 (Telephone) (71 uric yr utATN 03/03/2011 } SS Dorothy E GROVES (Supreme Court I.D. No.) 20558 PA LAST RESIDENCE 824 Lisburn Road, Apt. 512 Camp Hill. PA ~~n~~ FIGURES MUST BE TOTALED Personal Pronerh~ Cash ..................................................................... .......................... Personal Property ........................................................................ Stocks/Listed .......................................... ...................................... Stocks/Closely Held ..................................................................... Bonds .............................. .............................................................. Partnerships and Sole Proprietorships ..................................... Mortgages and Notes Receivable ............................................... 'All Other~Property `- _° ~ _ L~ ~G Total Personal Property ........................................ ,. - . cti~`~- "' ~ Total Real Property ................................................ L~ __. ~ ~ ~~~ Total Personal and Real Property ........................ J ``= 761-4540 CUMBERLAND COUNTY, PENNSYLVANIA File Number 21-11-00500 DECEDENTS SOC. SEC. N0. 206-1 p-8353 103,014.33 92,037.80 6,663.60 201,715.73 201,71'5.73 NOTE: The Memorandum of real estate outside the Commonwealth of Penns Ivania ma at the election of the item, but such figures should not be extended into the total of the Inventory. (See 20 Pa. C.S. § 3301(b)) personal representative include the value of each Form RW-09 Rey. ~a~s-zoos ~ T REGISTER OF WILLS OF INVENTORY CUMBERLAND COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA } couNTY OF Cumberland } ss DATE OF DEATH LAST RESIDENCE 03/03/2011 824 Lisburn Camo Hiii_ p ~b File Number 21-11-00500 Apt. 512 DECEDENTS SOC. SEC. NO. ~ 1 206-40-8353 Allstate Life and Annuity Claims -Annuity Contract No. GA053963 Beneficiary: Betty Headdings Prede 67 862 75 , ceased Decedent and passes to Estate , . Cash Bonus 100.00 Cash in Possession 66.00 Genworth Life Insurance Company - Reimbursement/Refund on Lon Te I C g rm are nsurance 899.84 MS<T Bank Money Market Account 17.42 M&T Bank Money Market Account under the Trust -Date of Death Value is #1 on EatateVal Valuati on 23,806.78 MBzT Classic Checking Account No. 38956411 -Statement for the Month of March is Attached to this Return 8,953.17 Parthemore Funeral Home -Refund of Overpayment 1,308.37 Total Cash 3to kQ/ ie ed 103,014.33 127.0000 shares Alpine Global Premier PPTYS FD - Com 886.46 Dorothy Groves Trust Agreement with M&T Investment Group -Date of Death Valuation from EstateVal is attached t thi o s Return 255.3430 shares Advisors Inner Circle Fund - Lsv Value Equity Fund 3,733.11 178.5190 shares Artio Global Invt. FDS Global High Yield 355.8880 shares Dryfus/Laurel FDS 1,876.23 5,921.98 (Attach additional sheets if necessary) Total Personal Pro e p rty and Real Estate 201,715.73 REGISTER OF WILLS OF INVENTORY CUMBERLAND COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA } COUNTY OF Cumberland } SS File Number 21-11-00500 DATE OF DEATH LAST RESIDENCE 03/03/2011 824 Lisburn Road, Apt. 512 DECEDENTS SOC. SEC. NO. Cam Hill PA 17011 206-10-8353 12.6620 shares Guinness Atkinson FDS China & H K FD -Com 43.6300 shares Harbor Fund -Intl Fund Institutional 54.0000 shares ING Clarion Global Re Estate Income -Com 103.7470 shares Institutional Equity Funds Inc - Lgcap Growth 65.1840 shares Lazard Funds Inc - Emerg Market Institutional 23.8390 shares Mainstay FDS TR Epoch GBL EQT I 87.0290 shares Masters Select Funds -Intl Fund 259.0920 shares MFS Series Trust X - Emer Market Debt I 46.1780 shares Morgan Stanley American Opportunity Fund -Shares Ben Interest CL D 2.770.4390 shares MTB Group FDS -Income Fund 433.2950 shares MTB Group Funds -Intl Equity -Intl Equity I I 324.6560 shares MTB Group Funds -Large Cap Growth Fund - Lcpgr Institutional I 261.7790 shares MTB Group Funds -Large Cap Value - Lcp Value Institutional I 108.7770 shares MTB Group Funds - MidCap -Mid CP GRW 1,633.2330 shares MTB Group Funds -Short Term Bonds - Strm Corp Bond I 72.1200 shares MTB Group Funds - Sm. Cap Growth - S CP GRW INS 770.7340 shares Ridgeworth FDS SEIX FLRT HI I 23.2840 shares RS INVT TR GLBL Nat Res Y 490.53 2,764.83 436.32 1,812.46 1,359.74 369.98 1,387.24 3,725.74 1,777.85 27,371.94 4,133.63 3,022.55 2.931.92 1,752.40 16,740.64 1,306.09 6,967.44 944.63 -2- INVENTORY REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA CouNTY OF Cumberland } ss f File Number 21-11-00500 DATE OF DEATH LAST RESIDENCE 03/03/2011 824 Lisburn Road, Apt. 512 DECEDENTS SOC. SEC. NO. Cam Hill PA 17011 206-10-8353 6.0000 shares SPDR Series Trust S8P Dividend ETF 324.08 Total Stocks/Listed 92,037.80 ~QRdS 9 United States Savings Bonds -Series EE -Valued using Savings Bond Calculator 6,663.60 Total Bonds 6,663.60 -3- J 15D5610143 REV-1500 ~`(°'-'°' " PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes oErnnnaENTOFrtevEnuE County Code Year File Number PO Box.2aosol INHERITANCE TAX RETURN 21 11 00500 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 206 10 8353 03 03 2011 06 O1 1912 Decedent's Last Name GROVES Suffix Decedent's First Name DOROTHY (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW X^ 1. Original Return ^ ^ 4. Limited Estate ^ © g. Decedent Died Testate (Attach Copy of Will) ^ Spouse's First Name MI E MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return ^ 3, Remainder Return (date of death prior to 12-13-82) 4a. Future Interest CompPromise) ^ 5. Federal Estate Tax Return Required (date of death after 12-12-82 ~' pAlt r~tM sin ned)a Living Trust 1 ( i G py of<~n,st 8. Total Number of Safe Deposit Boxes ^ 9. Lltlgation Proceeds Received ^ 1 p. S usal P vert Cred~t,~date r death b~tween 1p1-31 ~3f an -1-95~ ^ 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number EDMUND G MYERS (717) 761 4540 First line of address 301 MARKET STREET Second line of address PO BOX 109 City or Post Office State ZIP Code LEMOYNE PA 17043 REGISTER OR~N I L LS USE QIdtY ( '- +~ x..1..1 m~ I`rl -T`= (7 ' r.,'3 tW 7 : - r--~ r- _., p ~ ..IJ~~ L,'; ~ ~Tl ~.i C ~ -- - __ DA~'FILED r' r ., 1._~~ t 'e f.~ ~~ r°,d { _ ~-_ ~_ ,- _ ~~ } ,- r=-1 L~ J ~i Correspondent's a-mail address: egm~jdsw.com Under penalties of perjury, I deGare 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. DeGaretion of preparer other than the personal representative is based on all information of which preparer has any knowledge. aid W~URE OF PEFjppA-~SPONSIBLE FORP!-ING RETURN Karen L OF PREPARER OTHER THAN REPRESENTATIVE DATE EDMUND G MYERS h~ ~ ~ ~ ~~ f ADDRESS 301 MARKET STREET, Lemo ne, PA Side 1 15D5610143 150561D143 J 1505610243 REV-1500 EX Decedent's Name: GROVES, Dorothy E RECAPITULATION Decedent's Social Security Number 2 0 6 10 8353 1. Real Estate (Schedule A) ...................................................................................... . 1. 2. Stocks and Bonds (Schedule B) ............................................................................ . 2. 98 , 7 O 1 . 4 0 3. Closely Heid Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 4. Mortgages & Notes Receivable (Schedule D) ........................................................ 4. 5• Cash, Bank Deposits i~ Miscellaneous Personal Property (Schedule E) ............... 5. 35 , 151.5 8 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 7. Inter-Vivos Transfers & Miscellaneous I~n~ Probate Property (Schedule G) u Separate Billing Requested............ 6. 7• 43,308.03 8. Total Gross Assets (total Lines 1-7) ........................................... .......................... $. 277, 161 . O1 9. Funeral Expenses 8~ Administrative Costs (Schedule H) .............. ......................... 9. 19 , 5 64.16 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) .............................. 10. 1,274.00 11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 20, 838.16 12. Net Value of Estate (Line 8 minus Line 11) ................................ . ......................... 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .............................. ................. 12. 13. 256, 322.85 25, 632 .29 14. Net Value Subject to Tax (Line 12 minus Line 13) ................................ ~'~~°•••••••° TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable 1a. 230, 690.56 at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .00 16. Amount of Line 14 taxable 15. 0.00 at lineal rate X .045 0.00 17. Amount of Line 14 taxable 16. 0.00 at sibling rate X .12 0. 0 0 18. Amount of Line 14 taxable 17. 0. 0 0 at collateralrateX.15 230, 690.56 18. 34, 603.58 1s. Tax Due .................................................................................................................. 1s. 34, 603.58 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 1505610243 1505610243 J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENTS NAME GROVES, Dorothy E STREET ADDRESS 824 Lisburn Road, Apt. 512 CITY Camp Hill Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 25,000.00 1,315.79 Total Credits (A + B) (2) (3) File Number 21-11-00500 STATE ZIP PA 17011 (1) 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 34,603.58 26,315.79 (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 8287.79 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 :........................................................ Yes No 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, benefds or care? ............................................................ x 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?....... 4. Did decedent own an Individual Retirement Account, annu' contains a beneficiary designation? .............. ~~ or other non-probate property which ............................ F THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT A3 PART OF THE RETURN. For dates of death on or after July 1, 1994 and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 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 percent [72 P.S. §9116 (a) (1.2)j. . The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. . The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116 (a) (1.3)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Rev-1503 EX+ (6-88) COMMONVJEALTN OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS 8~ BONDS ESTATE OF , GROVES, Doroth E FILE NUMBER 21-11-00500 All property Jointlyowned with right of survivorship must tredisclosad on Schedule F. ITEM CUSIP NUMBER NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH Dorothy Groves Trust Agreement with M8~T Investment Group -Date of Death Valuation from EstateVal is attached to this Return 1 00758M634 255.343 shares of Advisors Inner Circle Fund - Lsv Value 14 62 Equity Fund . 3,733.11 2 04315J860 178.519 shares of Artio Global Invt. FDS Global High Yield 10 51 . 1,876.23 3 261980668 355.888 shares of Dryfus/Laurel FDS 16.64 5,921.98 4 402037207 12.662 shares of Guinness Atkinson FDS China 8 H K FD < - Com $g,74 490.53 5 411511306 43.63 shares of Harbor Fund -Intl Fund Institutional 63.37 2,764.83 6 449826104 54 shares of ING Clarion Global Re Estate Income -Com g Og , 436.32 7 45775L408 103.747 shares of Institutional Equity Funds Inc - Lgcap 17 47 Growth . 1,812.46 8 52106N889 65.184 shares of Lazard Funds Inc - Emerg Market 20 86 Institutional . 1,359.74 9 56o63J864 23.839 shares of Mainstay FDS TR Epoch GBL EQT I 15.52 369.98 10 576417208 87.029 shares of Masters Select Funds -Intl Fund 15 94 . 1,387.24 11 55273E640 259.092 shares of MFS Series Trust X - Emer Market Debt I 14 38 . 3,725.74 12 616933404 46.178 shares of Morgan Stanley American Opportunity 38 50 Fund -Shares Ben Interest CL D . 1,777.85 Total of Continuation Schedule I See attached page TOTAL (Also enter on Line 2, Recapitulation) 98,701.40 - ___.__.._. ~-e.... ..~ .~~~ aauic aiccr Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) Rev-7503 EX+ (6-98) COMMONWEALTH OF PENNSriVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS continued ESTATE OF GROVES FILE NUMBER 21-11-0OS00 ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 13 553767858 2,770.439 shares of MTB Group FDS -Income Fund g,gg 27,371.94 14 5537sT775 433.295 shares of MTB Group Funds - Intl E ui Equity I I q ty -Intl 9.54 4,133.63 15 553767742 324.656 shares of MTB Group Funds -Large Cap Growth Fund - Lcpgr Institutional I 9.31 3,022.55 16 553767668 261.779 shares of MTB Group Funds -Large Cap Value - Lcp Value Institutional I 11.20 2,931.92 17 553767510 108.777 shares of MTB Group Funds - MidCap -Mid CP GRW 16.11 1,752.40 18 553767189 1,633.233 shares of MTB Group Funds -Short Term Bonds - Strm Corp Bond I 10.25 16,740.64 19 553767148 72.12 shares of MTB Group Funds - Sm. Cap Growth - S CP GRW INS 18.11 1,306.09 20 766287678 770.734 shares of Ridgeworth FDS SEIX FLRT HI I 9.04 6,967.44 21 74972H648 23.284 shares of RS INVT TR GLBL Nat Res Y 40.57 944.63 22 78464A763 6 shares of SPDR Series Trust SBr,P Dividend ETF 54.015 324.09 23 02083A103 127 shares of Alpine Global Premier PPTYS FD - Com 6.98 886.46 24 9 United States Savings Bonds -Series EE ' Vatued using Savings Bond Calculator 6,663.60 TOTAL (Also enter on Line 2, Recapitulation) 98 701 40 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98) Rev-1508 EX+t6-96) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERTfANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER GROVES, Doroth E 21-11-0OS00 Include the pprooseds of IRigation end the date the proceeds were received by fhe estate. All property jointlyownedwith tha right of survivorship must be di l d sc osa on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Cash in Possession 68.00 2 Cash Bonus 100.00 3 M8rT Bank Money Market Account 17.42 4 MS<T Bank Money Market Account under the Trust -Date of Death Value is #1 on EstateV l a Valuation 23,808.78 5 MBrT Classic Checking Account No. 38956411 -Statement for the Month of March is Attached to this Return 8,953.17 6 Genworth Life Insurance Company - Reimbursement/Refund on Long Term Care Insuran ce 899.84 7 Parthemore Funeral Home -Refund of Overpayment 1,308.37 TOTAL (Also enter on Line 5, Recapitulation) I 35,151.58 (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) Rev1510 EX+ (B-98) CDNhtONVVEALTH OF PENNSYLVANIA INNERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF GROVES, Doroth E FILE NUMBER 21-11-OOS00 This schedule must be completed and riled if the answer fo any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM DESCRIPTION OF PROPERTY NUMBER THE DATErOFATRDAFNSF~ER SATTACIiTA COPY OFTTHE DEED FOR REAL EST TE % OF DECD'S INTEREST TAXABLE . VALUE OF ASSET (IF APPLICABLE) VALUE 1 All state Life and Annuity Claims -Annuity Contract 67 862 75 No. GA053963 , . 67,862.75 Beneficiary; Betty Headdings, Predeceased Decedent and passes to Estate 2 Allstate Life and Annuity Claims -Annuity Contract 75 269 25 No. GA054962 , . 75,269.25 Beneficiary: Phyllis Hoover and Arlene McCandlles 3 Pa Treasury Annuity Payment 176.03 176.03 TOTAL (Also enter on Line 7, Recapitulation) 143,308.03 (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 G (Rev. 6-98) --- REV-1151 EX+(10-06) COMM_Q. I L~OF_pE~RLVANIA SCHEDULE H FUNERAL EXPENSES ~ ADMINISTRATIVE COSTS ESTATE OF GROVES, Dorothy E FILE NUMBER 21-17 -00500 ITEM N A. FUNERAL EXPENSES: Debts of decedent must be reported on Schedule I. DESCRIPTION AMOUNT B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Karen L Headdin s Street Address 44 Banbury Road city Hummelstown state PA zio 17036 Year/s) Commission oaid 8,500.00 2. i4ttomev's Fees JOHNSON DUFFIE 8,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zio Relationshio of Claimant to Decedent 4. Probate Fees 345.50 5. Accountant's Fees 6. Tax Return Preparer's Fees ~~ C+ther Administrative Costs 2,218.66 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 19 564 16 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF E FILE NUMBER 21-11 ~nsnn ITEM NUMBER DESCRIPTION AMOUNT Othe Ad i i 1 r m n strative Costs Cumberland County Register of Wills Office -Filing Fees for Inheritance Tax Retum and Inventory 30.00 2 M&T Bank Investment Group -Trustee Fees -March 2011 171.18 3 M8T Bank Investment Group -Trustee Fees -April 2011 171.50 4 M8T Bank Investment Group -Trustee Fees -May 2011 1,129.70 5 MS<T Bank Investment Group -Trustee Fees -June 2011 155.53 6 Reserves -Additional Administrative Expenses 300.00 7 The Cumberland Law Journal -Notice of Estate Administration 75.00 8 The Patriot News -Notice of Estate Ad i i m n stration 185.75 H-B7 2,218.66 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+ (12-0a) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8t LIENS ESTATE OF E FILE NUMBER 21-11-oe5ee Report debts incurrod t>y the decedent prior M death that remained unpaid at the dste of death, including unreimbursed medical expenses, ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Holy Spirit Hospital 50.00 2 Ljubisa M. Stankovic MD -Medical Services 117.62 3 Penn Credit -Cumberland 2010 Per Capita Tax 36.00 4 Spartan Pharmacy 93.39 5 State Employees Retirement System -Refund for Overpayment 158.43 6 The Woods at Cedar Run 734.57 7 Verizon Telephone 21.65 8 Verizon Telephone 62.34 TOTAL (Also enter on Line 10, Recapitulation) I 1,274 00 (If more space Is needed, addrhonal pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) REV•1513 EX+I~~_pg) COMM_Qy_N~Try DDNNgYLVANIA SCHEDULE J BENEFICIARIES ESTATE OF GROVES, Doroth E NUMBER NAME AND ADDRESS OF PERSON(Sl RECEIVING PROPERTY I• TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 a 1.2 1 Woodrow Headdings 44 Banbury Road Hummelstown, PA 17036 2 Phyllis Hoover 4100 Holden Road Raleigh, NC 27616 3 Arlene A McCandless 530 Herman Street Harmony, PA 16037 4 Dianne Peredna 906 Drexel Hills Blvd. New Cumberland, PA 17070 FILE NUMBER 21-11-00500 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE DECEDENT (Words) ($$$) °riend 10% of Residue Niece ~ 35% of Residue Niece ~ 35% of Residue Friend ~ 10% of Residue Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 1500 cov~easheet, as a I NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 West Shore Baptist Church 25,632.29 • `~ • ~~ ~/~ r/1R 1 11 - CIY 1 CR ~ v i HL rv~N-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHE 25,632.29 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08) ESTATE OFDOROTHYE. GROVES SCHEDULE OF EXHIBITS EXHIBIT A Last Will and Testament for DOROTHY E. GROVES signed and dated October 1 S, 2011 EXHIBIT B EstateVal Valuation for Stocks being held in Trust by M&T Bank EXHIBIT C U.S. Savings Bond Calculator for 9 Series EE Savings Bonds EXHIBIT D M&T Bank Statement period ending March 4, 2011 showing value of account on date of death EXHIBIT E Allstate Date of Death Letter showing value of Annuity for Beneficiaries at Time of Death EXHIBIT F Allstate Date of Death Letter showing value of Annuity payable to Estate at Time of Death 461831 Last Will and Testament of DOROTHY E: GROVES I, DOROTHY E. GROVES, of Lower .Allen Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby. revoking and making void any and all Wills or Codicils at any time heretofore. made_by me. - ARTICLE I. DEBTS - I direct the payment -of all my legal debts, and the expenses of my last illness and funeral from my Estate as soon after my death as conveniently may be done. ARTICLE II: REST, RESIDUE AND REMAINDER I give, devise and bequeath all the rest, residue acid remainder of my `estate, of whatever nature and wherever situate, as follows: A. Ten (10%) percent. :,thereof unto WEST SHORE BAPTIST CHLT.I2CH, 2025 Market Street, Camp Hill, Pennsylvania 17011; 1 - '.B. Ten ~(10%) percent thereof unto my friend, DIANNE PEREDNA, New . Cumberland, Pennsylvania, provided she survives me; C. Thirty-Five (35%) percent thereof unto my niece, ARLENE ~A. McCANpLESS; Harmony, Pennsylvania, or her then-living issue, per. . _ s'tirpes, should she- predecease me; and D. Thirty-Five (35%) percent thereof unto my niece; PHYLLIS HOOVER, Raleigh, North Carolina, or her' then-living issue, per stirpes, should she predecease me; and E. Ten (10%) percent thereof unto my friend, WOODROW - HEADDINGS, Camp Hill, Pennsylvania, or his then-living issue, per stirpes, should. he predecease me. ARTICLE IlI TAXES I direct that all estate, inheritance, transfer and other taxes of similar nature payable by reason of my death, together with any interest or penalties thereon, and imposed with respect to any property, whether or not disposed of by this Will, shall. ' be paid out of the residue. of my Estate. I further direct that all such taxes shall be .paid from and be deducted from the residue of my estate prior to the distribution of the -shares of the residuary beneficiaries, so that each ~ residuary - :beneficiary, - charitable or not, -shall bear a portion of the burden of such taxes. 2 ARTICLE IV PERSONAL REPRESENTATIVE I name, constitute and appoint MANUFACTURERS AND TRADERS TRUST COMPANY, Harrisburg, Pennsylvania, Executor of this my Last WiII and Testament. - IN ~VI'TNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this ~~ any o f ~~~~ 2009. -. , - (SEAL) DOROTHY E. GRO - Signed, sealed, published and declared by the above-named Testatrix, as acid for her Last Will and Testament, in the presence of us, who at her request, in her presence and in-the presence ~ of each other, have hereunto subscribed our names as ` witnesses. 3 ,. .~ ~~... _ , - AFFIDAVIT AND ACKNOWLEDGMENT ; COMMONWEALTH OF PENNSYLVANIA ~ . SS COUNTY OF CUMBERLAND We, DOROTHY E. GROVES; ~i Y ~ ~ ~ S ~~ and ~~ ~`t l~~ -hJ~c U~~ ~~/~( the Testatrix and the witnesses, respectively, whose names are signed ~ to the attached or foregoing instrument, being: first duly sworn, ~do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the. Testatrix, signed the Will as witness and that to the best of his/her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. D ~ THY E. GRAVES Wi Subscribed, sworn to and acknowledged before me by .DOROTHY E. GROVESr Testatrix, and . su scribed and sworn- to before me by - and ~~(- ~ (r~(-1vt~L ,witnesses, this ~~~-'day of..~[~W "~ 2009. ~ - . - -z- . -. ~ ~ _ - Edmund G. My s Attorney I. ID. #20558 4 COMMONWEALTIi OF PENNSYLVANIA ; ss. COUNTY OF CUMBERLAND - On this, the ~ day of ~~ ~ ~ - ; 2009, before me, the undersigned officer, personally appeared EDMITND G. MYERS, Attorney I.D. #20558, known to me (ar satisfactorily proven) to be a member of the bar of the highest court of Pennsylvania. and subscribing witness to the within instrument, and certified that he was personally present when the foregoing acknowledgment and affidavit were signed by the Testatrix and the witnesses. IN WITNESS WHEREOF, I hereunto set my hand and official seal. ~J ~ Notary Public . COMMONWEALTH OF PENNSYLVANIA Notarial Seat Dana ~ VU~eman, Notary Public ~ Boro, Cumberland County ~' Comml~ F->~ires Jan. 15, 2013 Member, Pennsylvania Assodation of Notaries :378631v2 5 - - - __ - - "ca"'F'~ -"z .~ ::rte: _ ~ ~~- . - °:. - ~;:.-;~•~ - - --- - - _ - -- _ .r.,:.,-~....,,_._.~,..- _---_ _ - - . r ~~, L \ - i ~ , Y~\,:-'~~~~-`'~'~: Vii. ~r1c } :~t ,~~~'`s ~~ ~• ~~~~ f~'' ~C'~' - ~ ., - ._ ~. ' [ Date of Death: 03/03/2011 Valuation Date: 03/03/2011 Processing Date: 04/04/2011 Estate Valuation Estate of: Dorothy Groves Account: 1101397505 Report Type: Date of Death Number of Securities: 29 File ID: Estate Val -1101397505- Groves Shares Security Mean and/or Div and Int Security or Par Description High/Ask Low/Bid Adjustments Accruals Value 1) 23806.78 MTB GROUP FDS (553767429) MMKT INSTL I Mutual Fund (as quoted by NASDAQ) No pricing information 2) 355.888 DREYFUS/LAUREL FDS TR (261980666) INTL EQT CL T Mutual Fund (as quoted by NASDAQ) 03/03/2011 3) 259.092 MFS SERS TR X (55273E640) EMER MK DEBT I Mutual Fund (as quoted by NASDAQ) 03/03/2011 4) 178.519 ARTIO GLOBAL INVT FDS (09315J860) GLBL HIYLD I Mutual Fund (as quoted by NASDAQ) 03/03/2011 5) 2770.439 MTB GROUP FDS (553767858) INCOME I I Mutual.FUnd (as quoted by NASDAQ) 03/03/2011 6) 1633.233 MTB GROUP FDS (553767189) STRM CORP BD I I Mutual Fund (as quoted by NASDAQ) 03/03/2011 7) 770.734 RIDGEWORTH FDS (766267678) SEIX FLRT HI I Mutual Fund (as quoted by NASDAQ) 03/03/2011 8) 255.343 ADVISORS INNER CIRCLE FD (00758M634) LSV VAL EQ FD Mutual Fund (as quoted by NASDAQ) 03/03/2011 9) 46.178 MORGAN STANLEY FOCUS GROWTH (616933404; SBI CL I Mutual Fund (as quoted by NASDAQ) 03/03/2011 10) 324.656 MTB GROUP FDS (553767742) LGCP GRW INSTL ' Mutual Fund (as quoted by NASDAQ) 03/03/2011 11) 261.779 MTB GROUP FDS (553767668) LCP VAL INST I Mutual Fund (as quoted by NASDAQ) 03/03/2011 12) 108.777 MTB GROUP FDS (553767510) MID CP GRW I I Mutual Fund (as quoted by NASDAQ) 03/03/2011 N/A 16.64000 Mkt 16.640000 5,921.98 14.38000 Mkt 14.360000 3,725.74 10.51000 Mkt 10.510000 1,876.23 9.88000 Mkt 9.880000 27,371.94 10.25000 Mkt 10.250000 16,790.69 9.04000 Mkt 9.040000 6,967.94 14.62000 Mkt 14.620000 3,733.11 38.50000 Mkt 38.500000 1,777.85 9.31000 Mkt 9.310000 3,022.55 11.20000 Mkt 11.200000 2,931.92 16.11000 Mkt 16.110000 1,752.40 Page 1 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.1.1) Date of Death: 03/03/2011 Valuation Date: 03/03/2011 Processing Date: 04/04/2011 Total Value: Total Accrual: Total: $92,037.80 Estate of: Dorothy Groves Account: 1101397505 Report Type: Date of Death Number of Securities: 29 File ID: Estate Val -1101397505- Groves $0.00 $92,037.60 Page 3 This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions, please contact EVP Systems at (816) 313-6300 or www.evpsys.com. (Revision 7.1.1) Calculated Value of Your Paper Savings Bond(s) _ _ Page 1 of 1 Calculated Value of Your Paper Savings Bond(s) Calculator Results for Redemption Date 03/2011 Bonds: 1-9 of 9 D21701848EE EE $500 08/1989 08/2011; 08/2019 $250.00 $490.40 4.00% $740.40 D21701820EE EE $500 06/1989 06/2011 06/2019 $250.00 $490.40 4.00% $740.40 D21701849EE EE $500 08/1989 08/2011 08/2019 $250.00 $490.40 4.00% $740.40 D21701850EE EE $500 08/1989 08/2011 08/2019 $250.00 $490.40 4.00% $740.40 D21701823EE EE ,$500 07/1989 07/2011 07/2019 $250.00 $490.40 4.00% $740.40 D21701824EE D21701 5EE EE $500.07/1989 07/201.1 07/2019 $250.00 $490.40 4.00% - -- $740.40 82 EE $500 07/1989:07/2011 07/2.019 $250.00 $490.40 4.00% $740.40 D21701826EE EE $500 07/1989 07/2011 07/2019 $250.00 $490.40 4.00% $740.40 D21701821EE EE $500 06/1989 06/2011 06/2019 $250,.00 .$490.40 4.00% $740.40 Totals for 9 Bonds 2 250.00 4 413.60 6 663.60 NI Not Issued • NE Not eligible __ _..... for payment., P5 Includes 3 month interest penalty MA Matured and not earnin interest http://www.treasurydirect. gov/BC/SBCPrice 5/24/2011 FEB.OS-MAR. 04,2011 1 OF 1 29200 DOROTHY E GROVES BETTY C HEADDINGS C/O KAREN CUMMINS ONE M&T PLAZA 9TH FL BUFFALO NY 14203 INTEREST EARNED FOR STATEMENT PERIOD 0.00 Trrnrrnrm ormaneT ncr WEST SHORE PLAZA ' '~ ':::::$AT;A~S:;;:;: .. «;<::':A'1'IiER. ~A'~3bT'FF414S:?:`<': :~i:z<`::<':~i:~HE01C3<~PA2t1i:; is«:<~: ;~ z~::SS~TRAGTiON3:::;c;::;:::; •>: .. ::~ ax' .' . ;: NO. AMOUNT NO. AMOUNT NO. AMOUNT 9,016.16 2 1,491.03 0 0.00 3 1,554.02 0.00 8,953.17 02-OS-11 BEGINNING BALANCE $9,016.16 02-07-11 M&T BANK T3000 ACH 1,315.00 02-07-11 M&T BANK T3000 ACH 217.37 7,483.79 ~ 02-28-11 PA TREASURY DEPT ANNUITANT 176 03 . 7,659.82 03-02-11 VERIZON PaymentREC 21.65 7,638.17 03-03-11 US TREASURY 303 SOC SEC 1,315.00 8,953.17 ENDING BALANCE $8,953.17 WARM UP WITH SPECIAL SAVINGS THIS SPRING AT POPULAR RETAILERS WHEN YOII USE YOUR M&T CHECK CARD OR M&T VISA CREDIT CARD IN STORES, ON THE WEB AND OVER THE PHONE. PICK UP A COUPON BOOK AT YOUR LOCAL M&T BRANCH, OR VISIT MTB.COM/SHOPPING FOR GREAT DEALS ON SPRING SAVINGS. IF YOU PAY WITH YOIIR M&T CHECK CARD, BE SURE TO SELECT (OR ASK TO USE YOUR CARD AS) "CREDIT". Allstate You're in good hands. August 17, 2011 Dana Wieseman Law Offices Johnson Duffle 301 Market St, P.O. Box 109 Lemoyne, PA 17043-0109 Re: Dorothy Groves Contract No: GA0534962 Dear Ms. Wieseman: We received a request to complete IRS Form 712 for the above referenced contract. The purpose of Form 712 is to provide an estate or donor with the value of a life insurance contract or its proceeds as of a certain date (usually the owner's date of death or date of transfer of the contract). Because this contract is an annuity, it is not reportable on IRS Form 712. I can, however, provide the following information for estate purposes: Date of Death: March 3, 2011 Annuity Value as of Date of Death: $ 75,269.25` Cost Basis: $ 25,000.00 Named Beneficiary: Arlene M. McCandless & Phyllis M. Hoover *The actual amount paid may differ due to Market Value Adjustments and/or any applicable Surrender Charges. If you have any questions, please contact me at 1-877-499-6418 Ext. 24695. Sincerely, Theresa Parsons Sr. Claim Representative Allstate Life Insurance Company Life and Annuity Claims P.O. Box 94212, Palatine, IL 60094-4212 Phone 877-499-6418 Fax 866-635-4523 A I I state b You're in good hands. August 17, 2011 Diana Wieseman Law OfFces Johnson DufFe 301 Market St, P.O. Box 109 Lemoyne, PA 17043-0109 Re: Dorothy Groves Contract No: GA0534963 Dear Ms. Wieseman: We received a request to complete IRS Form 712 for the above referenced contract. The purpose of Form 712 is to provide an estate or donor with the value of a life insurance contract or its proceeds as of a certain date (usually the owner's date of death or date of transfer of the contract). Because this contract is an annuity contract, it is not reportable on IRS Form 712. I can, however, provide the following information for estate purposes: Date of Death: March 3, 2011 Annuity Value as of Date of Death: $67,862.75* Named Beneficiary: Estate of Dorothy Groves *This value is an illustration for estate purposes only. It does not represent a cash value or a lump sum withdrawal offer. Please contact us once the estate has closed and we can request the appropriate documents and send the paperwork that will be needed for the heirs of the estate to continue the payments. The Estate of Dorothy Groves will not be able to take a lump sum withdrawal If you have any questions, please contact me at 1-877-499-6418 Ext. 24695. Sincerely, Theresa Parsons Sr. Claim Representative Allstate Life Insurance Company Life and Annuity Claims P.O. Box 94212, Palatine, IL 60094-4212 Phone 877-499-6418 Fax 866-635-4523 _ _ ~a:) ~ ~ ~ ~ ~: ~ ~ ,~~ ,~ ~ ~.. u ~ j ~y y~ 0 dam' _~. ~o ~• s ?~ ~.Ct~ QRP~~N'S ~~~lR'' ~RLAND ~~0.. F'A J a C/~ V I- C/ w :~ ..~ ~~ ~~ ~~ ~~ ~~ M ~ ~ ~~ U M""q ., r^ w V J~ W O 3 a(`,/1 ~~ W O U ~ ~ O Q U d ~~~~~ J ~ W ~ ~ __ ~ 2 d. w ~ ~ w ~ m V `" w ~ z ~ ~ U Q L~ 0 F- IN s' I n i ~~~ ~~~