HomeMy WebLinkAbout05-07-14 (2) J 15056101D1
REV-1500 EX(nt-1o)
PA Department of Revenue Pennsylvania OFFICIAL USE ONLY
Bureau of Individual Taxes
County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 2 I IS D pQ q
Harrisburg,PA 17128-0601 RESIDENT DECEDENT O 1
ENTER DECEDENT INFORMATION BELOW
08/09/2013 05/12/1925
Decedent's Last Name Suffix Decedent's First Name MI
GRIFFIE JANE E
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
r31D 1.Original Return O 2.Supplemental Return O 3. Remainder Return(date of death
prior to 12-13-82)
O 4. Limited Estate O 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
C@D 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 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$ch.O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED To:-'-
Name Daytime Telephone Nu@' r A
THOMAS E. FLOWER rn
4 C->i
C>_ in
RNITMR�WILt�`USE bLb
1� ys r-- f;i Inn
First line of address
h �
FLOWER LAW, LLC o ::3 i
c, cD T c
Second line of address
10 W. HIGH ST --o f Wr N
City or Post Office State ZIP Code DATE FILEW-
CARLISLE PA 17013
Correspondent's e-mail address: TOM@FLOWER-LAW.COM
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 i e,correct and complete.D Iaration f preparer other than the personal representative is based on all information of which preparer has ny k oWedge.
SI N T RSO ON FOR F I RETURN
RE
F E L. RIFFIE, 162 EM R ON DRIVE, CARLISLE, PA 17015
S1=OF PR ER THAN REPRESENTATIVE QATE
l
ADDRES
FLOWER LAW, LLC; 10 W. HIGH ST; CARLISLE, PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610101 1505610101 J
J 1505610105
REV-1500 EX
RECAPITULATION
1. Real Estate(Schedule A). .. .. . . . ..... . . .. . .. . . ... .. .. ... .. .. . .. . ... . . 1. 72,750.00
2. Stocks and Bonds(Schedule B) . . . ... . . . .. . .. .. ... ... . . .. . . .. . .. . ... . . 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) .. . .. 3.
4. Mortgages and Notes Receivable(Schedule D) ... . .. . .. . .... . .. . ... .... . . 4.
5, Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).... . . 5. 2,76828
6. Jointly Owned Property(Schedule F) O Separate Billing Requested .. . . . .. 6.
7. Infer-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) C=) Separate Billing Requested,... . ... 7.
8. Total Gross Assets(total Lines 1 through 7).. . . .. . . .. . .. . .. . ... . .. .. . .. . 8. 75,518.28
9. Funeral Expenses and Administrative Costs(Schedule H)... . .. .... . .. .. . .. . 9. 28,208.75
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) . . .. . . .. . . ... . 10. 127.94
11. Total Deductions(total Lines 9 and 10). . . ... . ... . ... . .. . .. ..... . ... . . . . 11. 28,336.69
12. Net Value of Estate(Line 8 minus Line 11) .. . . .. . .. .. . . . ... . .... . .. . .. .. 12. 47,181.59
13. Charitable and Governmental Bequests/Sec 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. 47,181.59
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(s)(t2)X.0_ 15.
16. Amount of Line 14 taxable
at lineal rate X.0 45 47,181.59 16, 2,123.17
17. Amount of Line 14 taxable
at sibling rate X.12 17.
18. Amount of Line 14 taxable
at collateral rate X.15 18.
19. TAX DUE .. . . . . . . . . . , 19, 2,123.17
20, FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p
Side 2
1505610105 1505610105 J
REV-1500 EX Page 3 File Number — ' _ D /�
Decedent's Complete Address: `�
DECEDENT'S NAME
JANE E. GRIFFIE
STREETADDRESS
135 FROST ROAD
CITY STATE .. . ZIP
GARDNERS PA 17324
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) 2,123.17
2. Credits/Payments
A.Prior Payments
S.Discount
Total Credits(A+B) (2)
3. Interest
(3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4)
5. if Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 2,123.17
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
a. retain the use or income of the property transferred;,........................................___.........................................- ❑ ❑x
b. retain the right to designate who shall use the property transferred or its income:................. ................... ❑ 0
c. retain a reversionary interest:or.......................................................................................................................... ❑ 0
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ 0
2. If death occurred after Dec.12, 1982,did decedent transfer property within one year of death
without receiving adequate consideration?............................................................................................................. ❑ 0
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.,............ ❑ 0
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation? .__.............._.........................._...........................................,........................... ❑ ❑X
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994,and before 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 Jan. 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)].
• 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)1.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-1502 EX+(11-08)
pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
INMERNANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
JANE E. GRIFFIE 21-13-0899
All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property
would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts.
Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1' DWELLING HOUSE AND LOT, 165 FROST ROAD;SOUTH MIDDLETON TWP;
CUMBERLAND COUNTY TAX PARCEL NO.40-0-2676-004,SALE PRICE 72,750.00
TOTAL(Also enter on Line 1, Recapitulation.) $ 72,750.00
If more space is needed,insert additional sheets of the same size.
olij';---A• Settlement Statement (HUD-1) OMB Approval No.2502-0265
Type of Loan
7.❑FHA 2.❑RHS 3.❑Conv.Unins. 6.File Number: 7.Loan Number: 8.Mortgage Insurance Case Number:
PY014-13 1501768475
14.❑VA 5.❑X Conv.ins.
C,Note:This form is furnished to give you a statement of actual settlement casts.Amounts paid to and by the settlement agents are shown Items marked
"(p.o.c)"were paid outside the closing they are shown here for informational purposes and are not included in the totals.
D.Name&Address of Borrower. E.Name&Address of Seller: F.Name&Address of Lender:
Mikael W.Bohn,Bdanne E.Bohn The Estate of Jane E.Gnffie Franklin American Mortgage Company
329 North Hanover Street,Carlisle,PA 17013 135 Frost Road,Gardners,PA 17324 501 Corporate Centre Ddve,Suite 400,Franklir
TN 37067
G.Property Location: H.Settlement Agent: I.Settlement Date:05105/2014
135 Frost Road Pyramid Land Transfer LLC Disbursement Date:051052014
Gardners,PA 17324 26 West High Street,Carlisle,PA 17013
Parcel 40-442676-004,South Middleton
Township
Place of Settlement: TitieF�cpress
26 West High Street,Carlisle,PA 17013 Printed 05/052014 at 8:32 am
by RLM
100. Gross Amount Due from Borrower '400. Groan Amount Due to Seller
101. Contract sales price 75,000.00 401. Contract sales price 75,000.00
102. Personal property 402. Personal property
103. Settlement charges to borrower(line 1400) 4,594.69 403.
104, 404.
105. 405.
Adjustments for hems paid by seller In advance Adjustments for Hems paid by seller in advance
106. Cityhown taxes to 406. CityAawn taxes to
107. County taxes 05AM014 to 121312014 184.35 407. County taxes 05105/2014 to 12/312014 184.35
108. School Taxes 051052014 to 061302014 138.39 408. School Taxes 051052014 to 061302014 138.39
109. 409,
110. 410.
111. 411.
112. 412,
120. Gross Amount Due from Borrower 79,917.43 420. Gross Amount Due to Seller 75,322.74
200. Amounts Paid b or In Behalf of Borrower 500. Reductions In Amount Due to Seller
201. Depositor earnest money 500.00 501. Excess deposit(an instructions)
202. Principal amount of new loans) 71,250.00 502. Settlement charges to seller(line 1400) 13,263.07
203, Existing loos taken subject to 503. Existing loos taken subject to
204. 504. Payoff of first mortgage loan
205. 505. Payoff of second mortgage loan
206. 506.
207. Seller Assist 2,250.00 507. Seller Assist 2,250.00
208. 508.
209. 509.
Adjustments for Items unpaid by seller Ad ustments for Items unpaid b seller
210. City/town taxes to 510. Cityltawn taxes to
211. County taxes to 511. County taxes to
212. School Taxes to 512. School Taxes to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517,
218. 518.
219. 519.
220. Total Paid byftr Borrow 74,000.00 520. Total Reduction Amount Due Seller 15,513.07
300. Cash at Settlement fromlto Borrower 600. Cash at Settlement tohrom Seller
301, Gross amount due from borrower(line 120) 79,917.43 601. Gross mount due to seller(line 420) 75,322.74
302. Less amounts paid bylfor borrower(line 220) 74,000.00 602. Less reductions in amount due seller(line 520) 15,513.07
303. Cash ❑X From ❑ To Burrower 5,917.43 603. Cash ❑X To ❑ From Seller 59,809.67
.mil,,lmgw�cwnobdm.o�eMwnpauneumianmox..»mnmenYM ti.noni:mnae�'aune m.m.,on imea®4 nmmww.wwnw%PEEa�mw,eau�w.ain.nn,n,mman aone,neom
Previous editions are obsolete Page I of 4 HUD-]
.at Estate Broker Fees $5,095.00 Paid From Paid From
. ision of commission line 700 as follows: Borrower's Seller's
1$2250.00 to Help U Sell Defiler Funds at Funds at
102. $2845.00 to Goldwell Banker Settlement Settlement
703. Commission paid at settlement 5,095.00
800. Rema Pa able in Connection with Loan
801. Ouroriginationcharge (Includes Origination Point O.000Y or$0.00) $2,381.69 (from GFE#1)
802. Your credit or charge(poims)for the specific interest rate chosen $-1,523.33 (fmm GFE#2)
803. Your adjusted origination charges - (from GFE A) 858.36
804. Appraisal fee to Olde City Lending Solutions $425.00 P.O.C.B'(from GFE#3)
805. Credit report to Cody Financial FBO Credit Plus (fmm GFE#3) 26.42
8D6. Tax service la from GFE#3
807. Flood certification to from GFE#3
808. to
900. Rema R aired q Lender to be Paid In Advance
901. Daily interest charges fnnn from 05/0511014 to 0610112014 @$8.78421day (fmm GFE#10) 237.17
902. Mortgage insurance premium for months to (from GFE#3)
903. Homeowners insurance fort yearstoEriemsurance (from GFE#11) 571.00
904, months to from GFE#11
1000.Reserves Deposited with Lender
1001. Initial deposit for your escrow account (from GFE#9) 886.15
1002.Homeowners insurance 3 months Q$ 47.581month $142.74
1003.Mortgage insurance months $ 36.811month $
1004. Property taxes months $ Imonth
1005.County Was 5 months 0,$ 23.271month $116.35
1006.School Taxes 12 months @$ 73.85/month $886.20
1007.Aggregate Adjustment $-259.14
1100.TRle Cha ea
1101. Title services and lenders title insurance from GFE 9) 1,072.09
1102.Settlement or dosing fee to $
1103.Owners tge insurance-Old Republic National Tioe Insurance Co. hom GFE#5 16.50
1104. Lenders file insurance-Old Republic National Title Insurance Co. $896.00
1105. Lenders title policy limit$71,250.00 Lenders Policy
1106.Owners We policy limit$75,000.00 Owners Policy
1107.Agent's portion of the total title Insurance premium $798.12
to Pyramid Land Transfer LLC
1108.Underwriters portion of the total title insurance premlum $114.38
Lo Old Re ublic National Title Insurance Co.
1109.Closing Protection Letter to Pyramid Land Transfer,LL($75.00
1110.Attorney Fees to Flower taw,LLC 5,000.00
1200.Government'Recording and Transfer Charges
1201.Covemment recording charges $ (from GFE#7) 177.00
1202.Dead$67.00 Mortgage$101.00 Release$
1203.Transfer taxes $ (from GFE#8) 750.00
1204.CitylCounty,Ludstamps Deed$750.00 Mon e$
1205. Stale Taxistamps Deed$750.00 Mortgage$ 750.00
1206. peed$ mortgage$
1207.Electronic Filing Fee $9.00
1300.Additional.Settlement Charges
1301..Required services that you can shop for (from GFE#6)
1302. to
1303. to
1304.Tax Certification Fee to Jennifer Vamer 10.00
1305, 2014 County/Twp Taxes to Jennifer Varner 284.9
1306.Inheritance Tax Due to Register of Wills,Agent 2,123.17
Ott _ - t t 41 594.69 13,263.07
Raid outside of dosing by(B)cmower,(S)eller,(Qender,(I)nvestor,Bro(K)er.-Credit by lender shown on page 1.-*Credit by seller shown on page 1.
Previous editions are obsolete Page 2 of 4 HUD-3
REV-i5o8 EX+(u-io)
7 pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
JANE E. GRIFFIE 21-13-0899
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1, PNC BANK CHECKING ACCOUNT#51-4016-5089 2,768.28
TOTAL (Also enter on Line 5, Recapitulation) $ 2.768.28
If more space is needed, use additional sheets of paper of the same size.
Regular Checking Statement PNCBANK
PNC Bank
Primary account number:51-4018-5089
Page 1 of 4
For the period 07/23/2013 to 08121/2013 Number of enclosures:0
000882 Q For 24-hour banking,and transaction or
JANE E GRIFFIE interest rate information,sign on to
135 FROST RD PNC Bank Online Banking at pnc.com.
GARDNERS PA 17324-8812 'a For customer service call 1-888-PNC-BANK
Monday-Friday:7 AM-10 PM ET
Saturday&Sunday: 8 AM-5 PM ET
Para servicio en espafiol, 1-866-HOLA-PNC
Moving? Please contact us at 1-888-PNC-BANK
®Write to:Customer Service
PO Box 609
Pittsburgh PA 15230-9738
Visit us at PNC.com
TDDterminal: 1-800-531-1648
For hearing impaired clients only
Regular Checldng Account Summary Jane E Griffis
Account number- 51-4018-5089
Overdraft Protection has not been established for this account.
Please contact us if you would like to set up this service.
Overdraft Coverage-Your account is currently Opted-Out.
You or yourloint owner may revoke your opt-in or opt-out choice at any time.
To learn more about PNC Overdraft Solutions visit us online at pnc.com/overdraffsolutions.
Call 1-677-588-3605,visit any branch,or Sign on to PNC Online Banking,and selectthe"Overdraft -
Solutions"link under the Account Services section to manage both your Overdraft Coverage and Overdraft
Protection settings.
Balance Summary
Beginning Deposits and Checks and other Ending
balance other additions deductions balance
2,004.62 1,070.30 1,195.79 1,879.13
Average monthly Charges
balance and fees
2,181.67 3.00
Transaction Summary
Checks paid/ Check Card POS Check Card/Bankcard
withdrawals signed transactions POS PIN transactions
4 0 0
Total ATM PNC Bank Other Bank
transactions ATM transactions ATM transactions
0 0 0
Activity Detail
Deposits and Other Additions There was 1 Deposit or Other Addition
Date Amount Description totaling$7,070.30.
08/02 1,070.30 Direct Deposit-Xxsoc Sec
SSA Treas 310 XXXXX2231A
1'+
PNDMLT01-JOB91275-140-NN N N NN-002-002637
Regular Checking Statement
For the period 07/23/2013 to 08/21/2013
For 24-hour information,sign on to PNC Bank Online Banking JANE E GRIME
on pnc.00m. Primary account number:51-4018-5089
Account number:51-4018-5089-continued Page 2 of 4
Checks and Substitute Checks
:heck Date Reference Check Date Reference
comber Amount paid number number Amount paid number
3159 31.15 08/06 0843188x5 3161 - 886.15 08/13 084200544
3160 23.13 08/07 085208023
Gap in check sequence There were 3 checks listed totaling
$94OA3.
Online and Dectronic Banking Deductions There was 1 Online or Electronic Banking
Sale Amount Description Deduction totaling$102.36.
)7/23 102.36 Payment,E-Check lnspayment
Libertymutualins 3158
Other Deductions Therewere 2 Other Deductions totaling
)ate Amount Description $103•®®•
)7/25 150.00 Withdrawal Tel 04000176030048 -
)8/21 3.00 Check Images In Statement Fee
Daily Balance Detail
)ate Balance Date Balance Date Balance Date Balance
)7/23 1,902.26 08/02 2,822.56 08/07 2,76828 08/21 1,879.13
)7/25 1,752 26 08/06 2,791.41 08/13 1,882.13
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• Living under their means
• Contributing as much as possible to their 401(k)s or other retirement plans
• Starting to save at a young age
Palk to us today about how we can help put you on the right path to your retirement goals,with a free retirement review.Stop by any
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FORM166R-0111
REV-1511 EX+(10-09)
Il pennsylvania SCHEDULE H
DEPARTMENT DT REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
JANE E. GRIFFIE 21-13-0899
Decedent's debts must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. HOLLINGER FUNERAL HOME,PROFESSIONAL SERVICES,FACILITIES&EQUIPMENT 5,150.00
2. GRAVE OPENING,OBITS,FLOWERS,CLERGY, DEATH CERTIFICATES,STONE ENGRAVING 880.00
3. CASKET,BURIAL CONTAINER AND CARDS, BOOKS, ETC. 4,270.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)or Personal Representatives)
Street Address
City State _.—ZIP
Year(s)Commission Paid:
2. Attorney Fees:
7,500.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.)
Claimant
Street Address
City ............................ .. . .... ..... . .. State
Relationship of Claimant to Decedent
4. Probate Fees: 223.50
5. Accountant Fees:
6. Tax Return Preparer Fees:
7. PUBLICATION OF ESTATE NOTICES-(CUMB.LAW JOURNAL: 75.00;THE SENTINEL:189.54) 264.54
8, SEPTIC TANK INSPECTION AND SERVICE 620.00
9. REAL ESTATE AGENT'S COMMISSION&SETTLEMENT COSTS(SEE ATTACHED HUD-1) 5,855.00
10. MET ED,ELECTRIC SERVICE INCLUDING HEAT 1,237.75
11, FIRE&HAZARD PROPERTY INSURANCE 921.29
12. CONTINUATION SHEET TOTAL 1,286.67
TOTAL(Also enter on Line 9, Recapitulation) $ 28,208.75
If more space is needed,use additional sheets of paper of the same size.
niufffnger runeral Home & Crematory, Inc.
Eric L. Hol linger, Supervisor
Sot North Baltimore Ave. • Mount Holly Springs, Pennsylvania 17065
(717)486-3433
STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED
Charges are only for those items that you selected or that are required.If we are required by law or by a cemetery or crematory to use any items,we will
'explain the reason in writing below.
If you selected a funeral that may require embalming,such as a funeml viewing,you may have to pay for embalming.You do not have to pay for embalm-
ing you did not approve if yo selected anon eme9rs such as direct cremation cur immediate burial.If we charged for embalming,we wi 1 explain why below.
For the Service of �la�.a e e (rt>yu'
Date of Death q Ze a
Charge to:_ �X, 4-^ JCQ-l.- (ti Z. �wH,s ..a .fin . Q�ut�IS�c 17015
Name Address City State
A. CHARGE FOR SERVICES SELECTED; Other clothing
L PROFESSIONAL SERVICES
Services of Funeral Oirenor/Staff......5 Cremation um ...................f
Embalming .... ............. ..S (Description)
Other preparation of body
OTHER $
$ $
........ $.B........... . UZ`74
SUBTOTAL OF OP PROFESSIONAA TOTAL MERCHANDISE SELECTED ..........--
L SERVICES.........At $ /
2. FACILITIES AND SERVICES C.SPECIAL CHARGES:
Forwarding of remain m s
Use of hcidities and services for $
viewing(VisiutiorJWake) ..........$ (Funeral Home)
Use of holines and services Receiving of rearma from
for funeral ceremony ............$ S
Use of facilities and services for ft.)Home)
Memorial Service ...............$ hnmed'ure Budal .................5
Use of equipment and services Dbect Cremation .................$
for graveside service..........:..f $
Other use of hcilities SUBTOTAL OP SPECIAL CHARGES ............ $
D.CASH ADVANCED
.............................. Opening Grave ........... ......$ tt0
SUB-TOTAL OF PACrLmEs/EQUIPMENT' ....:.52 f Canerery,Equipment .....S 1el S
3. AUTOMOTIVE EQUIPMEM' Lot and Decd .....$
...............
Vehicle to transfer remains to Funenl Home Newspaper N xxxw load ...5 e...'.l,.S
local .... .....
$ , Newspaper NOmxx-Outof-town& Ay$
�$+
Nerse(casket c oach) �A Fvr:a
Telephone&Telegrams ............$
Airfare ........................$
Local ---
i . .................f
limousine Clergy/Mass Offering ..............$ ias
PaRbled c ies .......th 1!2...:.1
................ cvni icd Copies ..the Death /....
Family car Qniei Ise ......................$ -
Iml ........................S Police Escort ...
Flower car or Floral disposition Flowers..V"..�.k4..............f 'L l O
Local r/cIe ...................f f
Vault Service Charge...............$
Ind car/clergy car _
nl .... ...................f / $
S
local p,,, .rers $ l7
Out of town rarupomtion ..........$
$ $
..
SUBTOTAL OF AUTOMOTIVE EQUB Ai f SUBTOTAL OF ADVANCES .......................D $ I9d5 S0
'MENP ......
TOTAL OF PROFESSIONAL SERVICES, We charge you for our services N obtaining: 4 1 l S o°
(spevifP aub pdaarars(bat are marled-up,
FACILITIES AND AVMOTIVE t+'
EQUIPMENT .... ..Ac ?(f�..cer......
B.CHARGE FOR MERCHANDISE CIED: SUMMARY OF CHARGES
Casket...... Y ................f 2�p u A.Pmfeatimail services,Facilities and
(Description) t l SA. Equipment,and Automotive
Equipment ................. ...f 51 so
Other Receptacle .. C Special Cho ............... ....
............ I
(Descd tioN Pena c. .................I$
P D.Cash Advances ..E ..SECTIONS . ......
(Deaburial containe .............ftS9 PAID AT SE CHONI ......... $1II 9L",rjaj
.............
(Desaipuon) a-s�.-+e:� PAID AT TIME OF OR PRIOR 70
ARRANGEMENTS .............................. f \ Gd a a
Acknowledgement cards f BALANCE DUE ................................
Regvsaer book(s).. f REASON
Memory folders ..... ........f $hs �1ewAu Z4ha u.t
Prayer cards ............ .......S gamy law,cerome,,or cemmory requbemen6 have required the purchase
Temporary gave mark ............$ of any of the my is°P I a explained
below.
Burial dorhing. ..... $
1 agree that I love examined the items of goods and services selected above and found them to be correct and according India arrangements 1 have requested.I aclanowled,
receipt of copy of this Statement of Funeral Goods and Serve es 1 tad.1 represent that 1 have sufficient funds avadable for payment of the ash prim for the goods
and services selmcd.I also agreegr a to [85 off e}a within u days.I agtee m be family and severally liable audit anyone else who
signs below.A fare charge of per month amounting to per year will be applied to the unpaid balance hegirvrirtg T days
from the dare of this agreement.I will also pay to the Funeral Director all reasorn le costs paid by the Funeral Id eaor to collect amorous I we under this agreement.
Three costs may include attorneys'fees,coon costs and other costs.Any additional services or merchandise ordered or requested after the date of this agreement will
b,comad d pan of this agreement an th ost thereof will he reflected on the foul bill or garment.
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form.600 Revised 1/04
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Rosenberry's Septic Services �J -
8885 Pineville Road Invoice
Shippensburg,PA 17257 Date Invoice#
Phone# 717-532-4026
Fax# 717-532-7229 1/14/2014 9297
Bill To
'Help ;ell Detwiler Realty n�
Attn: Karen Detwiler,Owner/Broker
655 Forge Road /
Carlisle, PA 17013 I
DATE QTY DESCRIPTION LOCATION AMOUNT
1/15/2014 1 Pumped Septic Tank and Disposal- 135 Frost Road,Gardners 170.00
Regular Septic System
1/15/2014 1 Hydraulic Load Test&Inspection 450.00
PA tax
0.00
Thank you for the opportunity to be of service!
Total $620.00
Terms: Net 30 days. Interest 1'h%per month after 30 days which is an annual percentage rate of 18%.
REV-1512 EX+(12-08)
dpennsytvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
JANE E. GRIFFIE 21-13-0899
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. MET ED,ELECTRIC SERVICE 50.24
2. PHARMACY CO-PAY 20.00
3. CENTURYLINK,PHONE SERVICE 57.70
TOTAL(Also enter on Line 10, Recapitulation) $ 127.94
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10)
pennsylvania SCHEDULE 7
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
JANE E. GRIFFIE 21-13-0899
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
I. TODD GRIFFIE, 1883 Country Meadows Dr.,Sarasota,FL 34235 SON 1/3
2. KEITH GRIFFIE,60 Victory Church Road,Gardners,PA 17324 SON 113
3. JEFFREY L.GRIFFIE, 162 EMERSON DRIVE,CARLISLE, PA 17015 SON 1/3
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.
LAST WILL AND TESTAMENT
OF
JANE E. GRIFFIE
I,JANE E. GRIFFIE, of 135 Frost Road, Gardners, Pennsylvania, 17324,
being of sound and disposing mind, memory and understanding, do make, publish
and declare this as and for my Lasr.VI"ill_ and Testament, hereby revoking and making
void any and all former Wills, Codicils, or writings in the nature thereof, by me at any
time heretofore made.
FIRST: I hereby order and direct my Executrix or Executor, hereinafter
named, to pay all M)r just debts, funeral expenses, testamentary expenses and all
Inheritance, Estate, Transfer and Succession Taxes, as soon as may be convenientiv
done after my death, out of my residuary estate.
SECOND: I give my entire estate to my three sons,JEFFREY L.
GRIFFIE, KEITH A. GRIFFIE, and TODD E. GRIFFIE, in equal shares. I
direct that if any of my sons fail to survive me, the share which that son would have
received shall be paid in equal shares to the surviving sons, or if two fail to survive
me, the surviving son.
LASTLY: I nominate, constitute and appoint my sons,JEFFREY L.
GRIFFIE and KEITH A. GRIFFIE, to serve jointly as Executor and that no
personal representative shall be required to give bond or security for the performance
of his duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
day of� 2011.
J
Jat& E. Griffie �\
SIGNED, SEALED, PUBLISHED and
DECLARED in the presence of
COMMONWEALTH OF PENNSYLVANIA
ss
COUNTY OF CUMBERLAND
On this, the --/-6 day of August, 2011, before me _ I ll �el�/ . notary
public, the undersigned officer, personally appeared James D. Flower,Jr., of Flower
Law, LLC, known to me (or satisfactorily proven) to be a member of the bar of the
highest Court of said state, Supreme Court ID Number 27742, and a subscribing
witness to the within instrument; and certified that he was personally present when
Jane E. Griffie, the Testatrix, signed the attached or foregoing instrument, having
been duly qualified according to law, and having acknowledged to said attorney that
she signed and executed the instrument as her last will, that she signed it willingly, and
that she signed it as her free will and voluntary act for the purposes therein expressed.
In witness whereof, I hereunto set my hand and official seal. .
JatQ E. Griffie, TestatrR
ota blic
COMMONWEALTH OF PENNSYLVANIA
Wotaral Ssal
Nathan C.Wolf,Notary Public
Cadisle Boro,Cumbedand County
My Carntlission Expires April 19,2012
Mornber.Pennsylvania Association of Notaries
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
On this, the day of August, 2011, before me 1,1)0l,r otary
public, the undersigned officer, personally appeared James D. Flower,Jr., of Flower
Law, LLC, known to me (or satisfactorily proven) to be a member of the bar of the
highest Court of said state, Supreme Court ID Number 27742, and a subscribing
witness to the within instrument, and certified that he was personally present when he
and 1 e w�• c eL j�- uowey , whose names are signed to the attached instrument,
being duly- qualified according to law, did depose and say that they were present and
saw Testatrix sign and execute the instrument as her Last Will; that she signed
willingly and that she executed it as her free and voluntary act for the purposes therein
expressed; that each witness in the hearing and sight of the Testatrix signed the Will as
witnesses; and that to the best of their knowledge the Testatrix was at that time 18 or
more years of age, of sound nand and under no constraint or undue influence.
In witness whereof, I hereunto set my hand and official seal.
Witness
J
W, ess
MoNl-
C 5CIO B0 n,
A3 ammr r,_,r N tary Public
CWMONWFALTH OF PENNSYLVANIA
Nolariaf Seal
Nathan C.Wa13,Notary Pubfw
Carliste Boro,Cumberland County
My CWnmissio' um es APril 19,2012
Member, or
Association of Notaries