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HomeMy WebLinkAbout02-17-12 (2)~. . ~, OFFICIAL USE ONLY PA Department of Revenue PennsylvaMa Bureau of Indtvidual Taxes "'""~""~'" "~""~` Counly Code Year File Number Po Boxzso(ioi INHERITANCE TAX RETURN 2 1 1 1 0 0 7 6 7 Harrisburg. PA 17128-o6oi RESIDENT DECEDENT 1505610101 REV-1500 °` t°'-'°' d~!' Social Security Number Date of Death MMDDYYYY Da-te~-of Birth MMDDYYYY 2 0 1 1 6 1 9~ 0 5 1 8 0 1 1 r01~ 616-~ Decedents Last Name Suffix Decedent''s~Fi-rst~N-aim-e MI S ar ver ® 'Iv ~Inl IT -~ (If Applieabb) Enter Surviving Spouss's Information Below Spouse's Last Name Suffix ~S'p'ouse's First Name ~~''''(('' MI r r ® ~Blen t . -...rLl~ Spouse's Social Security Number T~~~ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 1 6 2 2 2 4 3 16~ REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Retum O 2. Supplemental Return O 3. Remainder Return (date of death pdor to 12-13.82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Retum Required death efter12-12-82) r 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 1 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telepho-n e-Number M ar. t i n R M c C a 1 e b ~ r 17 1.7_619_1 717~7~0~ REGISTER OF WILLS USE ONLY na 0 First line of address ~ ~ ran 219 E ast Ma i n St re et ~ ''r~ r; p0 c,. Second line of address ~ ~ - r "~ 1 ~ o r'~ _; E LED ~ ~F-• r? Clty or Post Office State ZIP Code '~ ~ e c h a n i c s b u r P A 1 7 0 5 ~' ,~ ~~ Correspondent's e-mail address: Under penalties of perjury, I dedare that I have examined this return, induding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, coned and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge: SIG RE OF PE N SPONSIBLE FOR FILING RETURN DATE ADDRESS Dennis L. Sarver Side 1 L 1505610101 1505610101 J s, 219 East Main Street. Mechanicsburg. PA 17055 PLEASE US ORIGINAL FORM ONLY J REV-1500 EX Decedent's Name: 1505610105 1. Real Estate (Schedule A) ............................................. 1. 2. Stocks and Bonds (Schedule B) ....................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship {Schedule C) ..... 3 4. Mortgages and Notes Receivable (Schedu~ D) ........................... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E). • • • • • • 5. 6. Jointly Owned PropeAy (Schedule F) O Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) O Separate BNling Requested. • .. • • • • 7. 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. 11. Total Deductions (total Lines 9 and 10) ................................. 11. 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. 14. Net Value SubJect to Tax (Line 12 minus Line 13) ........................ 14. TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0~ 16. Arhount of Line 14 taxable at Ilneal rate X .0 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 Decedent's Soaal Secudty Number 15. 16. 17. 18. 19. TAX DUE .........................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REF.U~;~iF,~,i~d1 OVERPAYMENT Side 2 1505610105 1505610105 O REV-1500 EJC Page 3 , , ~ , Decedent's Complete Address: Fik Number CEDENTS NAME Ivan L. Sarver STREET ADDRESS 11 Burgners Mill Road CITY Plainfield STATE PA ZIP 17081 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2' ~~~ 2,500.00 A. Prar Payments B. Discount 131.58 3. Interest 4. If Line 2 is greater than Lkre 1 + Line 3, enter the diflererrce. This is the OVERPAYMENT. FiN in oust on Page 2, Line 20 m request a rotund. (t) 3"306.8 Total Credits (A+ 13) (2) 2.631.58 (3) 0.00 (4) 0.00 5. H Line 1 + Lure 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 67 4 . ~Q Make check payable to: REGISTER aF WILLS, AGENT. PLEASE ANSWER THE FOLLOIMNG QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the Property trdnsfemed :........................................................................................ .. ^ b. retain the right to designate who shall use the property transferred or its inr:orrre : .......................................... .. ^ c. retain a reversanary interest; or ........................................................................................................................ .. ^ d. receire the promise for life of eiiher payments, benefits or care? .................................................................... .. ^ 2. If death occurred. after Dec. 12, t9t32, did decedent transfer property within one year of death without receiving adequate consideration? ............................................................................................................ .. ^ 3. Did decedent own an "in trust far" or payable-upon-death bank account or security at his or her death? ............ .. ^ 4. Did decedent own an irxtividual retirement account, annuity or other rron-probate property, which ...................................................................................... oartairls a beneficiary designation? ................................ ^ .. lF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COIMPLETE SCHEDULE G AND f ILE R AS 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 rtet value of transfers to or for the use of the surviving spouse is 3 pert~at [72RS. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the survving spocee is O perrxrrtt ]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 evearf the surviving spouse is the only t>evtefitrary. For dates of death on or after Juty 1, 2000: • The tax mate imposed on the net vaNie 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 pent or a stepparent of the child is 0 percent 172 P.S. §9116(aK1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal benefiaaries is 4.5 percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §911fi(a)(1)]. • The tax rate imposed on the net value of trarrefers to or for the use of the decedents sibl'mgs is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 8102, as an individuaV who has at least are parent in c~rrlmon with the decedent, whether by Mood or adoptan: REV-1508 EX +(1-97) SCHEDULE E CASH, BANK DEPOSITS, 8 MISC. PERSONAL PROPERTY Ivan L. Sarver SS~~ 201-16-1947 05/18/2011 21 2011 007_67 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 1. Citizens Bank, - Checking Account ~~6231189094, opened by Deceden 15,882.12 08/10/2010; principal balance as of D.O.D.: $15,882.08; interest accrued to D.O.D.: $ 0.04. 2 Citizens Bank, - Performance Money Market Account ~p6231189787, 12,042.10 opened by Decedent 09/29/2010;. principal balance as of D.O.D.: $12,041.90; interest accrued to D.O.D.: $ 0.20. 3 Citizens Bank, - Certificate of Deposit Account ~~6244375497, 48,348.84 opened by Decedent 08/16/2004; principal balance as of D.O.D.: $48,347.25; interest accrued to D.O.D.: $ 1.59. 4 Members 1st Federal Credit Onion, - Savings Account ~~9680-00, 170.60 opened by Decedent 10/01/1974; principal balance as of D.O.D.: $ 170.58; interest accrued to D.O.D.: $ 0.02. 5 Members 1st Federal Credit Union, - Life Savings Account 4,000.47 ~~9680-04, opened by Decedent 02/01/2001; principal balance as of D.O.D.: $ 4,000.00; interest accrued to D.O.D.: $ 0.47. 6 1998 Buick LeSabre Custom automobile, - (needs several regairs). 1,400.00 7 1990 Buick LeSabre automobile. 300.00 8 A.G.A.I., Inc., - refund of cancer insurance premium. 28.75 9 Myers-Buhrig Funeral Home and Crematory, Ltd., - pre-need funeral 7,954.00 contract. TOTAL lAlso enter on line 5, F (If more space is needed, insert additional sheets of the same size) Copyright (0)1996 form software only CPSystems, lrK. 90,126.88 Form REV-1508 EX (Rev. 1.97) REV-,5„ EX ~ (,-9'n SCHEbULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES $ INHERITANCETA%RETURN RESIDENT DECEDENT A~M~N~$TRAT~VE CiOSTS ca i w r c yr ~ flLE NUMBER Ivan L. Sarver 5S~~ 201-16-1947 05/18/2011 21-2011 00767 Debts of decedent must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 Myers-Buhrig Funeral F3ome and Crematory, Ltd., - funeral expense. 9,990.00 B. ADMINISTRATIVE COSTS: 1. 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: 2. Attorney's Fees Law Offices-Marlin R. McCaleb 5,600.00 3. Famiry Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address CiA' State Zip Relationship of Claimant to Decedent 4. Probate Fees Register of Wills 277.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Citizens Bank, - service charge for Estate checking account. 2.00 2 Citizens Bank, - service charge. 2.00 3 Citizens Bank, - charge for printing checks. 13.06 4 Citizens Bank, - service charge. 2 00 5 Citizens Bank, - service charge. 2.00 6 Citizens Sank, - service charge. 2.00 Total of Continuation Schedule(s) 676.28 TOTAL (Also enter on line 9, Recapitulation) S 16 , 566.84 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 farm software ony CPSystems, Inc. Form REV-1511 EX (Rev. ,-97) Estate of: Ivan L. Sarver Soc Sec ~~: 201-16-1947 Date of Death: 05/18/2011 Continuation of Schedule H-B7 (Other Administrative Costs) Item Description ~~ 7 Citizens Bank, - service fee. 8 Citizens Bank, - service fee. 9 Citizens Bank, - service charge. 10 Citizens Bank, - service charge. 11 Citizens Bank, - service charge. 12 Citizens Bank, - service fee. 13 Cumberland Law Journal, - advertising Letters. 14 Register of Wills, - filing Inventory and Appraisement. 15 Register of Wills, - reserve for filing Account, Releases, etc. 16 The Patriot-News, - advertising Letters. Amount 2.00 2.00 2.00 2.00 2.00 2.00 75.00 30.00 300.00 259.28 676.28 REV-1573 EX i (9-pp) SCHEDULE) BENEFICIApIES ESTATE OF FILE NUMBER Tvan T._ Sarver SS~6 701.-] h-1 9[x7 05118/2011 2T -2011 -007b7 LA 10 IP 0 C A O 0 R NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS[Inciudeoutrightspousaldlstrlbutions,and transfers under Sec. 9716(a)(1.2)j 1 Dennis L. Sarver Son 37,919.77 270 Xoungs Church Road Shermans Dale, PA 17090 2 Cheryl A. Nickel Daughter 35,548.78 11 Burgners Mill Road Plainfield, PA 17081 ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON R EV 1500 COVER SHEET 11. 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 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET S 0.00 Ut more space Is neeaea, Insert aGCttlonal sheets of the same size) Copyright (e) 2000 Form software only The Lackner Group, Ine. Form REV-t513 EX (Rev. 9-00) -~ . LAST WILL AND TESTAMENT I, IVAN L. SARVER, of the Borough of Mechanicsburg, County of Cumberland and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and. declare this as and for my Last Will and Testament, hereby revoking and making void all former wills and codicils by me at any time heretofore made. FIRST. I order and direct that all my just debts and funeral expenses be paid by my Executor or my Executrix, as the case may be, hereinafter named, as soon as conveniently may be done after my decease. SECOND. I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, whatsoever and wheresoever situate, in I 'equal shares unto my children, namely: DENNIS L. SARVER, of Shermans Dale, Pennsylvania, and CHERYL ANN NICKEL, of Plainfield, Pennsylvania, share and share alike, absolutely and in fee simple. LASTLY. I nominate, constitute and appoint my son, DENNIS L. SARVER, Executor of this, my Last Will and Testament, but if for any reason he shall fail to qualify as such Executor or cease so to serve, then I nominate, constitute and appoint my daughter, CHERYL ANN NICKEL, to serve in his place and stead, each to serve without bond in this or any other jurisdiction. IN WITNESS WHEREOF, I, IVAN L. SARVER, have hereunto set my hand UW OFFICES LIIJ R. McCALE6 and seal to this, my Last Will and Testament which consists of two (2) typewritten pages to each of which I have affixed my signature this ^~'L day of A.D., Two Thousand Ten (2010). G~~ ~` ~ (SEAL) The preceding instrument, consisting of this and one (1) other typewritten page, each identified by the signature of the Testator, was on the date thereof signed, sealed, published and declared by IVAN L. SARVER, the Testator therein named, as and for his Last Will and Testament, in the presence of us, who, at his request, in his presence, and in the presence of each other, have subscribed our names as witnesses hereto. 1 -_~. LAW OFFICES 2LIN R. McCALE6 _2_ ~~ ~ One Citizens Drive ROP112 Riverside, RI 02915 July 20, 2011 Law Offices Of Marlin R. McCaleb Frankberger Place PO Box 230 219 East Main Street Mechanicsburg PA 17055 Estate of NAN L SARVER Date of Death: May 18, 2011 SSN: 201-16-1947 Dear Sir/Madam: In accordance with your request, the attached information sheet has been provided in the above decedent's. name as of his/her date of death. For Instalhr:;nt Loans or Line of Credit accounts, contact our Loan Department at 1-800-708 ,.58p, For all other inquiries, please call 1-877-579-2667 Sincerely, _ 'sten L. Petrucci Decedent Account Processing REF#: 497039 "schedule E.1, E.2 and E.3" ~~~ ~~- Account Number 6231189094 Account Title NAN L SARVER Date erred 8!4/2010 Account T e Checkin Princi al Balance as of DOD $15882.08 Interest from Last Postin to DOD $ .04 Account Balance as of DOD $15882.12 YTD Interest to DOD $4.08 °Schedule E.1, E.2 and E.3" t~ ~- Account Number 6231189787 Account Title NAN L SARVER Date erred 9!29/2010 Account T e Checkin Princi alBalance as of DOD $12041.90 Interest from Last Postin to DOD $ .20 Account Balance as of DOD $12042.10 YTD Interest to DOD $21,03 `Schedule E.1, E.2 and E.3` C~tiz~ts B~tl~- Account Number 6244375497 Account Title IVAN L SARVER Date erred 8/16/2004 Account T e Time De osits Princi al Balance as of DOD $48347.25 Interest from Last Postin to DOD $1.59 Account Balance as of DOD $48348.84 YTD Interest to DOD $68.53 "Schedule E.1, E.2 and E.3" .. ~ MEMBERS 1"~ P®4R Ai.CRBDrf UNION PRIMARY OWNER: Ivan L. Sarver SAVINGS ACCOUNT: Account Number/Suffix 9060-00 Date Account Established 10(01!1974 Prindpal Balance at Date of Death $170.58 Accrued Interest to Date of Death $.02 Total Prindpal ahd Accrued Interest $170.60 Name of Joint Owner None UFE SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Prindpal Balance at Date of Death Accrued Interest to Date of Death Total Prindpal and Accrued Interest Name of Joint Owner 9880-04• 02f01l2001 $4,000.00 $.47 $4,000.47 None Opened by a transfer of funds from the Savings Account 9680-00, originally established on 10/01/1974 PRIMARY OWNER: Dennis L. Sarver SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Prindpal Balance at Date of Deafh Accrued Interest to Date of Death Total Prindpal and Accrued Interest Name of Joint Owner Date Joint Ownership Established CHECKING ACCOU Account Number/Suffix Date Account Established Prindpal Balance at Date of Death Accrued Intereat to Date of Death Total Prindpal and Accrued interest Name of Joint Owner Date Joint Ownership Established 24554-00 06/25!1980 $2,018.25 $.22 $2,018.47 Ivan L. Sarver 06/25/1980 24554-11 03/22/1986 $2,723.39 $0.00 $2,723.39 Ivan L. Sarver 0 312 2/1 98 6 MEMBERS 1S7C/~FI/E//D/~ER~AL G~RE~D~~ITy,U~N~IO~N, Leig~Stallings '`r"'._ -~6 Lending Insurence SuppoR Specialist July 19, 2011 Estate of: Ivan L. Sarver Date of Death: 05/18/2011 Social Security Number: 201-i8-1947 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslst.org "Schedule E.4 and E.5" Graham Motor Company, Ins - ~~-C , o~ o~.~ X95'8 .~_~•C.~ r~C c° ~ucx ~~ ~~. _.. ,~~® - ~~ Graham Motor Company, Inc. 1402 Rally Pike, Carlisle, PA 170!3 ,' ~ Jrck Conley Sales Manager Phom: (7/7J 143-3066 I Fax: 717-149-7998 I K'~'~+:Srahammotors.rnm 1402 Holly Fake, Carlisle, Pennsylvania 17013 • Telephone 717-243-3066 • FAX 717-2~9-7998 - "Schedule E.6 and F_7~~ Y - ,~~fi,~z u _ ,_ -. . ,: _. .. ' ~ i t~ieryl Ann Nickel 1 i Burgaers M(II_Road. PO Box 31 Planfield, PA 17081 IN~I~lCE lnvace. Num. ber: 1(1040 Invoice pate: May 21, 2011 Page: 1 FSE Faciities Staff arld Egtapment $1,192.00 V Vehicles $1,080.00 M Men;harxiise $1,445.00 C:A~emete Crash Advance - C:~netery $ 1,335.00 CA-Newspi 'Crash Advance -Newspapers $385.00 CA-Clergy OastrAdvance -Clergy $ 100.00 CA-Death C Cash. Advance - [>aath Certificates $ 48.00 CA-Flower< Crash Advance -Flowers $ 200.00 CA-Honor ( Cash Advance -Honor Guard $ 100.00 M Merohandise -Flag Case, Beveled Glass $ 85.00 Subtolal $ 9,990.00 Shipping $ 0.00 Sales Tax $ 4.00 Total Irrvoice Amount $ 9,990.00 PaymentlCredit Details: C10012 Paymentr~Ctgd{t ied $ 7,954.00 Past due ao~o~mts are subJect to fete diarges of l.5%perm.m~th. Thank you for allowing us to serve. you and your family. Robert L. Buhrlg, Jr., FD, CFSP, Supervisor - Melissa A Etter,. FD - (717) 766-3421 -fax: {717) 795-7291 DirecRa~Myers-Buhrig.com - 37 East Main Street -Mechanicsburg -Pennsylvania - 17055 "Schedule E.9" PRIMARY OWNER: Ivan L. Sarver SAVING3 ACCOUNT• Account NumbedSuffix 9880-00 Date Account Established 10!01!1974 Prindpal Balance at Date of Death $170.58 Accrued Intermit to Date of Death $.02 Total Prindpal and Accrued Interest $170.80 Name of Joint Owner None ~ IFE SAVINGS ACCOUNT Account NumbedSuffix Date Axount Established Prindpai Balance at Date of Death Accrued Interest to Date of Death Total Prindpal and Axrued Interest Name of Joint Owner 9680-04" 02/01!2001 $4,000.00 $.47 $4,000.47 None ' Opened by a transfer of funds from Oie Savings Account9680-00, originally established on 10/01/1974 PRIMARY OWNER: Dennis L. Sarver SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Prindpal and Accrued Interest Name of Joint Owner Date Joint Ownership Established CHECKMG ACCOUNT: Account NumbedSuffix Date Account Established Prindpal Balance at Date of Death Accrued Interest to Date of Death Total Prindpal and Accrued Interest Name of Joint Owner Date Joint Ownership Established 24554.00 06!25!1980 $2,018.25 $.22 $2,018.47 Ivan L. Sarver 0 612 5/1 9 8 0 2455411 03/22H 988 $2,723.39 $O.DO $2,723.39 Ivan L. Sarver 03/22/1986 MEMBERS 1sT FEDERAL CcR?EDIT UNION Leigheigh`^~Stallm" 9S __ '~""" ~t Lending Insurance Support Spedalist July 19, 2011 Estate of: Ivan L. Sarver Date of Death: 018/2011 Social Security Number: 201-16-1947 5000 Ionise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslstorg " Schedule F.1 and F.2" T Comments 05/10!11 - 05/17/11 Room & Board 8 $302.00 $2,416.00 $2,416.00 TOTAL BALANCE DUE: ~ 1u~~1'~1 c~i~~o4 $2,416.00 v : ~d . K . n W j. n _ Y.. 5.., t , ~, 1 4 P FACILITY NAME RESIDENT NAME ACCOUNT NUMBER CHURCH OF GOD HOME, INC IVAN L SARVER 803054 "Schedule I-1"