HomeMy WebLinkAbout08-18-14 (2) 1505611186
REV-1500 EX(02-11)(FI)
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania
Department f R.v nae County Code Year Fife Number
DO Bureau
BO of Individual Taxes
I
Po sox zaoadl NHERITANCE TAX RETURN 21-13-100
Harrisburg,PA 17128-r601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
05202013 09121922
Decedent's Last Name Suffix Decedent's First Name MI
CLELLAND CLARA R
(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 BOXES BELOW
1. Original Return - ❑ 2. Supplemental Return ❑ 3. Remainder Return(Date of Death
Prior to 12-13-82)
❑ 4. Limited Estate ❑ 4a. Future Interest Compromise(date of ❑ 5. Federal Estate Tax Return Required
death after 12-12-82)
® 6. Decedent Died Testate ❑ 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
❑ 9. Litigation Proceeds Received ❑ 10. Spousal Poverty Credit(Date of Death ❑ 11. Election to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT• THIS SECTION MUST BE COMPLETED,ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name - Daytime Telephone Number
KENNETH P. CELLLAND 717-243633
REGISTER S USE O 'Y -.+
.O-rJ r- C'
First Line of Address
130 OLD STONE HOUSE RD o` °O
c ,
Second Line of Address
D Cn i O
City or Post Office State ZIP Code
GATE FILED
CARLISLE PA 170159771
Correspondents email address;
Under penalties of perjury, I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and complete.Dec Lion of pre arer other than the personal representative is based on all information of which preparer has any knowedge.
SIGNATURE OF P SO ESPONSiB ING TURN DATE
(KENNETH P. CLELLAND, EXECUTOR) 1��/�Gj
ADDRES f
130 OLP STONE HOUSE ARLISLE PA 17015-9771
SIG ft P p�.1 REP NTATIVE DATE
I (R. WM. WIRE, JR. , CPA) 8/14/2014
ADDRESS
R WM WIRE ASSOC., P-C. 19 SOUTH 19TH STREET CAMP HIL PA 17011
PLEASE USE ORIGINAL FORM ONLY
Side 1
(„! 1505611186 3W4647 5.000 1505611186
r
1505611286
REV-1500 EX(FI)
Decedent's Social Security Number
0acedenrs Name: CLARA R. CLELLAND
RECAPITULATION
1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 0 00
2. Stocks and Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . 2. 1562 47 .
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C). . . . - 3, 0 00
4. Mortgages and Notes Receivable(Schedule D) , , , , , , , , , , , , 4, 0 00
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E) 5. 135295 13
6. Jointly Owned Properly(Schedule F) ❑ Separate Billing Requested , . , , 6. 0 00
7, Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested . . . . 7. 0 00
8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . 8. 136857 60
9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . 9. 18622 33
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) , - , , , , , , , 10, 77669 25
11. Total Deductions(total Lines 9 and 10), , , , , , , , , , , , , , , , , , , , , 11. 96291 58
12. Net Value of Estate(Line 8 minus Line 11) , , , , , _ , , , _ , , , 12. 40566 02
13. Charitable and Governmental Bequests/Sec 0113 Trusts for which
an election to tax has not been made(Schedule J), , , , , , , , , , , , , , , 13, 0 00
14. Not Value Subject to Tax(Line 12 minus Line 13) _ , , , , , , , _ , , 14. 40566 02
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- 0 00 15. 0 00
16. Amount of Line 14 taxable
at lineal rate x.045 40566 02 16, 1825 47
17. Amount of Line 14 taxable
at sibling rate X.12 0 00 17 0 00
18. Amount of Line 14 taxable
at collateral rate X.15 0 00 18, 0 00
19, TAX DUE . . .. . . . 19.
1825 47
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Side 2
1505611286 1505611286
3 W464B 5.000
REV-1500 EX(FI) Page File Number 21-13-1007
'Decedent's Complete Address:
DECEDENTS NAME
CLARA R. CLELLAND
STREETADDRESS
130 OLD STONE HOUSE ROAD
CITY STATE ZIP
CARLISLE PA 17015-9771
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 1825
2, CredilsfPayments
A.Prior Payments 0
B. Discount 0
Tctal Credits(A+B) (2) 0
3. Interest
(3) 68
4. If Line 2 is greater than Line 1+Line 3,enter the difference.This is the OVERPAYMENT.
Fill In box on Page 2, Line 20 to request refund. (4) 0
5. If Line 1 + Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 1893
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 r
a. retain the use or income of the property transferred . . . . . . . . . . . . . . . . . . . . . . . .
b. retain the right to designate who shall use the property transferred or its income . . . . . . . . . .
c. retain a reversionary interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
d, receive the promise for life of either payments,benefits or care? . . . . . . . . . . . . . . . . . .
2. If death occurred after Dec. 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,annuity,or other non-probate property,which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑
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)(1)].
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 172 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. Q116(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. Q116(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.
3w4e71 3,000
REV-1503 EX t(6-12)
pennsylvania SCHEDULE B
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CLARA R. CLELLAND 21-13-1003
All property Jointly owned with right of survivorship must he disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1, HUNTINGTON BANCSHARES, INC. 1,562.47
— CUSIP 446150104
— 202 SHARES COMMON CAPITAL STOCK
TOTAL (Also enter on Line 2,Recapitulation) I$ 1,562.47
3W4696 1 000 If more space is needed, insert additional sheets of the same size
Estate Valuation _
Date of Death: 05/20/2013 Estate of: CLARA R. CLELLAND
Valuation Date: 05/20/2013 Report Type: Date of Death
Number of Securities: 1
Processing Date: 08/11/2014 File ID: CLELLAND
Shares Security Mean and/or Div and Int Security
or Par Description High/ASk Low/Bid Adjustments Accruals Value
1) 202 HUNTINGTON BANCSHARES INC (446150104)
CON
The NASDAQ Stook Market LLC 7,78000 7.69000 H/L
05/20/2013 7.735000 1,562.47
.47
'
Total value:
Total Accrual: $0.00 $1,562
Total: $1,562.47 -
Page 1
This report was produced with EstateVal, a product of Estate valuations a Pricing Systems, Inc. If you have questions,
please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.3.1)
REV-1508 EX.(0612) .
pennsylvania SCHEDULE E
DEPAR WINI OF REVENUE CASH, BANK DEPOSITS&MISC.
RESIDENT RETURN PERSONAL PROPERTY
INHERITANCE
D DECEDENT
.ESTATE OF: - FILE NUMBER: -
CLARA R CLELLAND 21-13-1003 _
Include the proceeds of litigation and the date the proceeds wrens received by the estate.
All property jointly owned with right of sumlvorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH _
1. 1. PNC SANK, N.A. 2,360.05
— REGULAR CHECKING ACCOUNT
— A/C #51-1431-2929
2. HUNTINGTON BANK 75,937.94
- REGULAR CHECKING ACCOUNT
— A/C #02532018643
3. CASH ON HAND AT DEATH 221.14
4. FURNITURE/PERSONAL PROPERTY 631. 60
— FURNITURE SAL98 (JUNE, 2013 THROUGH AUGUST, 2013)
5. SEARS 100.23
- REFUND OF PRO—RATED MAINTENANCE AGREEMENT ON WV RESIDENCE
SOLD 4/29/2013 (6/10/2013)
6. HOSPITALISTS OF CENTRAL PA 13.78
REFUND OF PAYMENTS FOR MEDICAL SERVICES (7/8/2013)
7. QUANTUM IMAGING SOLUTIONS 198.00
— REFUND OF PAYMENTS FOR MEDICAL SERVICES (8/13/2013)
8. ' CHURCH OF GOD RETIREMENT COMMUNITY 55,480.00
— REFUND OF PRO—RATED RETIREMENT COMMUNITY ENTRANCE
FEES (9/27/2013)
9. STONERIDGE LIFE INSURANCE COMPANY 30.39
— REFUND OF LIFE INSURANCE PREMIUM (12/6/2013)
10. 2013 FEDERAL AND STATE INCOME TAX REFUNDS RECEIVABLE 322.00
TOTAL(Also enter on line 5,Recapitulation) $ 135,295.13_
3w46AD 1.000 If more space is needed,use additional sheets of paper of the same size.
Performance Checking Account Statement Q PNCBANK
PNC Bank
Primary account number:51.1431-2929
Page 1of2
For the period 04126/2013 to 05/28/2013 Number of enclosures:0
000397 p For 24-hour banking,and transaction or
CLARA R CLELLAND TmE'interest rate information,sign on to
KENNETH P CLELLAND JR PNC Bank Online Banking at pne.com.
825 N HANOVER ST APT 306 4 For customer service call 1-888-PNC-BANK
CARLISLE PA 17013-2043 Monday-Friday: 7AM- 10 PM ET
Saturday&Sunday: 8 AM-5 PM ET
Para servicio en espatioi, 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 pne.com
TOO terminal:1.800-531-1648
For hearing impaired clients only
Performance Checidng Clara eClelland
Interest Checking Account Summary Kenneth PCleiland Jr
Account number: 51-1431-2929
Overdraft Protection has not been established forthis account.
Please contact us if you would like to set up this service.
Overdraft Coverage-Your account is currentlyopted-Out.
You or your joint owner may revoke your opt-in or opt-out choice at anytime.
To learn more about PNC Overdraft Solutions visit us online at pne.com/overdra @solutions.
Call 1-877-588-3665,visit any branch,or Sign onto PNC Online Banking,and selwtthe"Overdraft
SotutioW link underthe Account Services section to manage both your Overdraft Coverage and Overdraft
Protection settings,
Balance Summary
Beginning Deposits and Checks and other Ending
balance otheradditions deductions balance
1,431.97 928.08 .00 2,360.05
Average monthly Charges
balance andfeas
2,163.1.7 .00
Interest Summary As of 05126,a total of$.01 in interest was
Annual Percentage Number of days Average collected Interest Paid paid thisyear.
Yield Earned (APYE) in interest period balance for APYE this period
ODD 33 2,111.72 .01
Activity Detail
Deposits and Other Additions There were 2 Deposits and Other Additions
Date Amount Description totaling$028.0$.
05/03 928.07 Deposit Reference No. 523828422
05/28 .01. Interest Payment
Daily Balance Detail
Date Balance Date Balance Date Balance
04/26 1,431.97 05/03 2,360.04 05/28 2,360.05
1:
PNDMLTO t-J 0670137-N40-NNNN NN-001-000677
t .T J!k
Account Information Huntington Club ..-8843
Today's Beginning Balance $59,805.03
Pending Transactions $0.00
Account Balance $59,806.03
Nickname Huntington Club
Type Huntington Club
Overdraft Protection (ODP) None
Expanded Account Information
Interest Earned but Not Paid $0.21
Previous Year Interest $0.58
Year To Date Interest $0.95
Pending Transactions
No transactions found for today.
Transaction History
From 01101/2013 To 06/20/2013
Dater Number Type Payee Category debit Credit, Account
Balance
06111!2013 0 6503 Check SUBSTITUTE CHECK l�-1 -$SO.Op $59,805.03
06111/2013 0 6502 Check SUBSTITUTE CHECK 6�t 5 o[ 1 $100.00 $59,855.03
06/06/2013 0 Interest INTEREST PAYMENT $0.54 $59,955.03
06103/2013 6501 Check SUBSTITUTE CHECK ( —X150.00 $59,954,49
05/24/2013 [ 6498 Check SUBSTITUTE CHECK �c� ��e..�c J_r -$20.80 $60,104.49
05124/2013 0 6496 Check SUBSTITUTE CHECK c j�a -$207.30 $60,12529
0 �it2U
3 nn
05/23/201 6499 Check SUBSTITUTE CHECK } Lc -$15,518.83 Fo $60,332.59
05/23/2013 6497 Check SUBSTITUTE CHECK -$86.62 $75,851.42
05/1412013 6492 Electronic Debit STATE FARM RO 7 j�� -$177.37 $75,937.94
PYMT
05/13/2013 0 6494 Check SUBSTITUTE CHECK 5381.60 $76,115.31
05/10/2013 6490 Electronic Debit DOMINION RESOURC -$137.18 $76,496.91
ARC
05/10/2013 6488 Check SUBSTITUTE CHECK' $51,89 $76,634.09
05109/2013 0 6489 Check SUBSTITUTE CHECK -$798.00 $76,685.98
05/08/2013 0 Interest INTEREST PAYMENT $0.21 $76,883.98
05/03/2013 0 Direct Deposit SSA TREAS 310 $1,078.60 $76,88377
REV-1511 EX-(M13) SCHEDULE H
pennsylvania
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENTCECEDENT FILE NUMBER
.ESTATE OF
21-13-1003
CLARA R. CLELLAND
Decedent's debts must be reported on Schedule I.
ITEM AMOUNT
NUMBER DESCRIPTION -
A. FUNERAL EXPENSES:
1. FORD FUNERAL HOME, INC. (FAIRMONT, WV) 15,518.83
2. ST. STEPHEN'S CHURCH (CHURCH UTILIZATION GIFTS) 150.00
3. ST. STEPHEN'S ORGANIST FUND (ORGANIST HONORARIUM) 150.00
4. PASTOR GLASS (PASTOR'S HONORARIUM) 150.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
2. Attorney Fees:
3. 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
4. Probate Fees: - 153.50
5. Accountant Fees: 2,000-.00
6. Tax Return Preparer Fees: 500.00
7.
TOTAL(Also enter on Line 9,Recapitulation) $ 18,622.33
3w46AO 2.0D0 If more space is needed, use additional sheets of paper of the same size.
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REV-1512 EX,(12-12) SCHEDULE
_ Penn nsylvania
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENTDECEDENT
ESTATE OF FILE NUMBER
CLARA R. CLELLAND 21-13-1003
Report debts incurred by the decedent prior to death that remained unpaid at the data of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
KENNETH P. CLELLAND (DECEDANT'S SON) 38,092.50
130 OLD STONEHOUSE ROAD
CARLISE, PA 17015-9771
-SEE DESCRIPTIVE DETAIL (BELOW)
2. WILLIAM E. CLELLAND (DECEDANT'S SON) 38,092.50
130 OLD STONE HOUSE ROAD
CARLISLE, PA 17015-9771
-SEE DESCRIPTIVE DETAIL (BELOW)
DECEDENT'S SONS LOANED CASH TO THE DECEDANT IN THE SPRING OF 2012
FOR THE PRIMARY PURPOSE OF PAYING ENTRANCE FEES FOR THE DECEDENT AT THE
'CHURCH OF GOD' RETIREMENT COMMUNITY IN CARLISLE, PA. LOAN PROCEEDS
WERE TO BE REPAID UTILIZING PROCEEDS FROM THE SALE OF DECEDENT'S
PRIOR PERSONAL RESIDENCE LOCATED IN FAIRMONT, WV. RESIDENCE WAS
EVENTUALLY SOLD (4/29/2013 - PRIOR TO DECEDENT'S DEATH) BUT
LOANS WERE NOT REPAID PRIOR TO DATE OF DEATH.
TOTAL LOANS ARE EVIDENCED BY SONS' PAYMENMT OF THE FOLLOWING ITEMS:
A. 'CHURCH OF GOD' ENTRANCE FEE $ 73,000.00
B. CONSTRUCTION CONTRACT TO MODIFY BATH/SHOWER 825.00
FACILITIES IN RETIRMENT UNIT.
C. SOUTHLARE VILLAGE RETIREMENT COMMUNITY IN 2,040.00
LEXINGTON, SC FOR TEMPORARY LIVING/VACATION
FACILITIES
D. 'ALWAYS BEST CARE SENIOR SERVICES' FOR CLIENT 320.00
SERVICES WHILE TEMPORARILY RESIDING AT
SOUTHLARE VILLAGE
TOTAL ADVANCES/LOANS TO DECEDENT $ 76,185.00
-SEE RELATED ATTACHMENTS
TOTAL FROM PAGE 2 1,484.25
TOTAL(Also enter on Line 10,Recapitulation) $ 77,669.25
aw46AN I.000 If more space is needed,insert additional sheets of the same size.
REV-1512 EX+(12-12) SCHEDULE
pennsylvania
E)EFARTMENT 01 REVENUE DEBTS OF DECEDENT,
MHERITANCE TAX RETURN I MORTGAGE LIABILITIES & LIENS i
RESIDEM DECEDENT _
ESTATE OF FILE NUMBER
CLARA R. CLELLAND 21-13-1003 _
Report debts incurred by the decedent prior to death that remained unpaid at the data of death,Including unrelmbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1a"'
3. CITY OF FAIRMONT, WV 207.30
— FINAL TRASH/WATER/SEWER SERVICE (WV RESIDENCE SOLD 4/29/2013)
— PAID 5/24/2013 (CK #6496)
4. CARLISLE ENT ASSOCIATES 20.80
— BALANCE FOR MEDICAL SERVICES
— PAID 5/24/2013 (CK #6498)
5. GOODWILL EMS 85.78
— MEDICAL TRANSPORT
— PAID 6/20/2013 (CK #6504)
6. TERMINIX 73.14
— FINAL PEST CONTROL SERVICES (WV RESIDENCE SOLD 4/29/2013)
— PAID 6/24/2013 (CK #6507)
7, CARLISLE PHYSICIANS 33.31
BALANCE FOR MEDICAL SERVICES
PAID 6/25/2013 (CK #6505)
S. QUANTUM IMAGING SOLUTIONS 160.00
BALANCE FOR MEDICAL SERVICES
— PAID 6/26/2013 (CK #6506)
9. SHERIFF — MAGILL COUNTY, WV 49.46
— FINAL PERSONAL PROPERTY TAX (MARION CO. , WV)
— PAID 7/30/2013 (CK #6508)
10. CHURCH OF GOD RETIREMENT COMMUNITY 374.05
MONTHLY FEES & MISC. SERVICES
PAID 8/14/2013 (CK #114)
11. DR. DARYL GUISTWITE 37.22
— BALANCE FOR MEDICAL SERVICES
— PAID 8/25/2013 (CK #112)
12. CHURCH OF GOD RETIREMENT COMMUNITY 356.67
— MONTHLY FEES & MISC SERVICES
— PAID 10/21/2013 (CK #1003)
13. HOSPITALISTS OF CENTRAL PA 86.52
— BALANCE FOR MEDICAL SERVICES
— PAID 5/23/2013 (CK #6497)
PAGE TOTAL 1,484.25
TOTAL(Also enter on Line 10,Recapitulation) $ --- _
3w46AH 1 OW If more spew is needed,insert additional sheets of the same size.
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SECTION S '- RZFU=&
UPON TERMINATION OF THIS AGREEMENT, COMMUNITY SHALL. REFUND
THE ENTRANCE FEE. IN ACCORDANCE WITH THE FOLLOWING PROVISIONS:
A. Termination Before Occupancy
THE ENTRANCE FEE, BUT NOT THE APPLICATION FEE, WILL BE
REFUNDED IN FULL IF RESIDENT RESCINDS THIS AGREEMENT WITHIN SEVEN
(7} DAYS IN ACCORDANCE WITH THE NOTICE OF RIGHT TO RESCIND. IN
THE EVENT OF TERMINATION OF THIS AGREEMENT BY DEATH OF RESIDENT
OR BY COMMUNITY BEFORE OCCUPANCY, OR IN ,TAE EVENT RESIDENT PRIOR
'T10 , OCCUPANCY IS PRECLUDED FROM BECOM—TNG- A RESIDENT BECAUSE OF
ILLNESS-, INJURY OR INCAPACITY, THEN COMMUNITY SHALL MAK2- A FULL
REFUND OF ALL ENTRANCE FEE PAYMENTS . AND THE APPLICATION FEE. IF
RESIDENT DOES NOT TERMINkT.E THIS AGREEMENT WITHIN THE SEVEN (7)
DAY RECISSION PERIOD' BUT DOES TERMSNATE PRIOR TO OCCUPANCY WHILE
NOT PRECLUDED FROM TAKING OCCUPANCY BY ILLNESS, INJURY OR
INCAPACITY, THEN. .. COMMUNITY SHALL ._RETAIN* THE AMOUNT : PAID .AS AN
APPLICATI01UPEE AND ANY MONTHLY FEES PAID IN ADVANCE. THE BALANCE
OF THE ENTRANCE FEE SHALL BE REFUNDED TO RESIDENT LESS ANY
AMOUNTS DEDUCTED TO COVER THE CCSTS OF EXPENSES. INCURRED AT THE
SPECIFIC WRITTEN- REQUEST OF RESIDENT, SUCH AS EXPENSES FOR
OPTIONAL APPLIANCES/FURNISHINGS-OR STRUCTURAL CHANGES,
B. Amortization 'Of Part Of,_Fntrance Fee
ONE HUNDRED(1'00%) OF TBE ENTRANCE FEE.JILL BE AMORTIZED AT is �
THE;RATE OF 4%DA1 EDIAT'ELY UPON ENTRANCE AND.2 %A TviONTH
UNTIL IT IS FULLY AMQRTL7ED IKFOUR
C Termuxa.tion:.Atter:O�cup'a�ic4;
'� . .
... .. . .. . ...... . ..
IN THE EVENT:OF TERIvfWAllON OF THIS AGREEMENT DURING TBE FIRST
FOI2TX—EzGxT-*)MONTFTS OF OCCUPANCY, THE UNAMORTIZED .
REMAINDER OF THIS" ENTRANCE FEE,SHALL.BE REFUNDED.TO
. . '_OR RESIDENT':S ESTATE::
t11'TER-48Iv10I�THS OF OCCUPANCY;THERE IS NO
-EQt}I2Y REi T3RN. "AN Y REFUNDS OTIIEIZWISE DUE RESIDEN SFIAI I BB
REDUCED BY ANY AMOUNTS OF FINANCIAL ASSISTANCE PROVII7ED
RESIDENT IN ACCORDANCE WITH COMMUNITY'S FINANCIAL ASSISTANCE
POLICY,OR FOR NECESSARY REPAIRS.
2 . NO INTEREST SHALL ACCRUE TO THE BENEFIT OF THE
RESIDENT ON ANY AMOUNTS REQUIRED TO BE REFUNDED UNDER THIS
AGREEMENT, AND NO INTEREST WILL BE PAID ON TERMINATION.
-18-- •
(b) An Amortized Part equal to one hundred (100%)percent of
the Entrance Fee, which will be amortized 4%immediately upon
move-in and then at the rate of two (2 %) Percent per month from
the date Of Occupancy for a period of forty-eight(48)months.
4 . After the execution of this-Agreement and I the initial
payment, there will be no increases in the Entrance Fee prior to
Occupancy.
The entire Entrance Fee shall be used by Community for
any corporate Purpose and in any manner deemed appropriate by
Community in its sole and absolute discretion consistent with
law_ The Entrance Fee is not held
Resident, and in trust for the benefit of
community assumes no fiduciary Obligations with
respect to the Entrance Fee'.
B. Fee for Optional Furnishings
The fee of $
appliances/furnishings, if 'Alli for Optional
applicable, must be paid bef ore the
acquisition of the optional items and
request by the community. within ten (ID) days of
C. Monthly Fee
1. Resident shall pay to c
$ A's 'oo Community a Monthly Fee of
in. advance each month : � Payment
Monthly Fee is due thirty Of the� first
(30) days prior , to the Designated or
Extended Occupancy Date. All subsequent
day of� each month thereafter are dueon the
ereafter i=ed;L4.t
invoice from Community. , , ,
monthly .ij kslY upon: receipt of a
2 . CoirmnnitY will provide' a ,r,On t_h'jY jr ,
the ,* hmount:��due ,f invoice which shall'
or. he-Nonthly Fee, and any , other' s� which
Eire chargeable to Resident. if an s
Y. Monthly, Fee or charge is not
Paid, within thirty (30) days of delivery Of
Community may terminate this Agreement , the invoice; then
surrender the apartment unit. and require Resident to
3 . The Monthly Fee may be increased: 0.r adjusted'
to time. sted from time
ity will give at least thirty (30) days advance
written notice of any changes or increases in the Monthly Fee.
Resident should anticipate at a minimum increases in the Monthly
Fee comparable to annual increases in the United States
Price Index (CPI) Published by the Consumer
Bureau of Labor Statistic U.S. Department
I S. Fee increases of Labor,
increases in the CPI and may Occur in any Year may exceed
annual basis . more frequently than on an
R. Long Term Care Insurance
Community reserves the right to require Residents to
purchase and enter into a contract f or long term care insurance
with an insurance carrier approved by community. Alternately,
Community reserves the right to purchase group or individual long
term care insurance . benefits for residents and to pass the cost
of such insurance to Residents. The costs for such insurance
will be added to the Monthly Fee.
SECTION 4 : FEES
A. Application aad Entrance Fees
1. Application Fee
Resident shall pay to Community the sum of one Thousand
($1, 000. 00) Dollars as an Application Fee, which will be credited '
toward the Entrance Fee payment.
2- Entrance Fee
?:asident shall pay to Community the sum of $ '7�j 1 6'Q as
an Entrance Fee in accordance with the schedule below, and, if
applicable, an additional fee of $ ^/fj for optional
appliances/furnishings:
(a) . The sum of Ten Thousand ($10;000)Dollars;plus the 60 0 PO
Application Fee Credit (i.e. $10,000+ $1,000 $11,000 U
as an initial a ment at ) / O U P Q. .5
p Y the time of execution agreement:
(b) The sum of $ �pZ � 00 b reflecting .the
balance of the Entrance 'Fee as a final payment
on or before the Designated or Extended
Occupancy Date.
3 . Components of Entrance Fee
-Zl�bv
The Entrance Fee has two components : 2
(a) An Equity Refund equal to zero (0 %) percent ] ,
of the Entrance Fee; and
-8-
t
BATH CREST
388 Sleepy Hollow Rd. /Shermans Dale, PA 17090
//��
(717)582-8874
�e2� 1503 PA 19606 AUTHORIZED aATHCRM DEALER
��WW INVOICE / BILLING
Le ?`,n r4 rya ro r C y" r l�^`� l�Cr,�, ;�4Z;rV.f Ken c I e u a n Q
Job Site Name Bill To
t3OL I ;C) 0 Q CTov\ r ' i().J S-e tea
Street Addr1r,,Sl /7�/- �Gf �I } � Street Address-t
`�' N
City State Zip city State Zip
Home`` /Phone Work Phone K/r A Home Phone Work Phone
COLOR:4 j h 11`t Date Work Completed:
Special Notes:
`` 5YEAR LIMITED WARRANTY h` `'''" ° °'+' Description/item Amount
// C. 1 lJ?
.._ ..__. _ _ t;.t its., �i h.7S �4Ct h- $
The BathCrest-fraochiseJiQfo111�^-- ---- i _
B H g CRESST $
TM $
Acrylic Tub&Wall Svstems
Tub Repair• porcelain&Fiberglass Refinishing $
388 Sleepy Hollow Road $
Larry'7ubman'Brown,Owner Shermans Dale,PA 17090
(717)582-8874 www.bathcresLCOm $
(717)582-7966 Fax PA019606
Free Estimates
..,, wmpuance $
w,ui me care&Maintenance instructions. $
All repair work is warranted for a period of(90) ninety days. c– cJ
Total Due $ G4J
TERMS AND CONDITIONS
1. All work is due and payable when completed unless prior arrangements in writing have been specifically make. A"Repeat
Billing Charge"will be added to all accounts 30 days old. We also reserve the right to charge interest at 2% per month (24%
per annum) on balances 30 days or older. In the event any amount due hereunder is not paid as agreed, the undersigned
jointly and severally agree to pay all costs incurred in said unpaid balance, including a reasonable attorney's fee.
2. Customer hereby acknowledges receipt of a copy of this agreement. No oral agreements are accepted.
'+}t�],°WU£,. . ..tYV:np .
SPRAYEti ACKNOWLEDGEMENT,' + «.wstCUSTOMER"ACKNOWLEDGEMENT ..
w :.u:�
Customer hereby acknowledges the receipt of this contract and
® I have resurfaced the above items. And have used the prescribed care and maintenance, also that the resurfaced
the OSHA approved respirator and safety equipment. I have area shall not have a non-skid surface, unless customer
followed the BathCrrest resurfacing methods and procedures. specifically orders a noon'-skid surface.
`[ / �/5 /0- ` V / 6 —/ /—
ESTIM OR'S.S GNATURE DATE CUSTOMER'S SIGNATUR DATE
t
Front: Bill and Deborah Clelland<billclel@windstream.neb
Subject: Fwd:Always Best Care forms
Date: May 29,2012 9:06:54 PM EDT
To: Ken Cleiland<KenClelland @comcast.net>
a 4 Attachments,213 KB
Begin forwarded message:
From:Heidi Peek tek h 'o@ shoo com>
Date:May 29,2012 8:16:16 PM EDT
To:.billclel@windstream.net
Subject:Always Best Care forms
Good evening,
It was a pleasure meeting with you and your mom this morning.I have attached a Copy of the forms we discussed.Please let me know if you have any questions.Your mom is such a
delight and 1 enjoyed spending time with her this morning!
Thanks so much!
Heidi Peek -
Always Best Care
Care Coordinator
803-673-7047
.'l'("[P f%/✓ CLIENT SERVICE AGREEMENT
BESTCR
_ � E
Intmdne fte.
Csvn has requested Net Always Bert Cave of the hlNlaeda NBC)cidir—to onubet ale
w mNined in MIs Agamnmt R�onible Petty het mrtetl o ranee ABCN be➢eld fm
Me smiru Provided here under. If R,pnlble Parry is a legal guodiml or cmauveirr of
Client ResproMic Petty h,du ainhat h mar into this eprome nt on behelfacum,
ABC u en iMepmdeN Ramhiem of Ne Alweye Hell Grt Senior Saviw System.ABC alto
is mryom ble for providing smtced to Client undo Nis Agreement nis Agreement is snared
into location AlOa re
ys Bost Co ,an indepnMm e t feomber of Me Always Beat Cart Senior
Service System,Client and PrrsPwuibk Petry.
client Oln fretr—I Phone 910wm-5,I4A
CBanranddms I12e4
City sc ZIPCOm Qao]2
Always B,t C.a FSancnien(ABC) N�dlnw At Pnpne Mv4.K4t
Add-, 51440 Ti. .rl full S:ter 237
City Cnl.r..bta. zip rose �9ao
A ICHmac CartSmlces:
Rot,art desennind by Me a arad Pric,Lies-
Pace es-based w acuity level of Ns-Client et ale.of cart and subject to avisien ifacuity -
leml amps m cost of living in . ABC mama Me right W terminea amiu if
peymmt is delimuem or ifthis agmrnrmm acv Occurs. cal -
Hirleg argod"m: ABC invests considerable time and many rtaritin&hiring.and
Properly waning its m ivry"Cart Providers'. For this from,Me Climt Me Client's
family,end Rnpomfiic Puy apm Miry will nee indsp ordeni,hire any employee of ABC
during Ne tern citrus Client Sauce Agmanrn within twelve(I2)wmbue fiom Me des of
is metim of orrviw. I(Ne Client m R,ponsiEle Perry hlrta m ABC employee m former
employee within twelve(13)wonder of Me date wr,AOm art ttmmirWed under this Agavomt
Me Client wR,psmible Perry.Insouciantly pay ABC$9,000.
Hondays: Pa company WI¢y,time and me hall-(16)will M charged for Me following
holidays:-
Ne,You'sBey Good Friday nowerSmtlry Thanksgiving
Indepurdmm Day Chrisunv Day
Belli 4 Payment: DB NOT my Me Cormimr(m my smioo AgC will invoice mmtbly
far sevicso rmdertd. Payment rs due upn sails- If payment is im 2ow-c by ABC wii in
30-0ays a(Me invoices dads,a 10%late fc will be imposed. Me agree that uABC rtfem my
exomn to a mllWim suivia m legal counsel,Ma will Pay all rmsonable collectim_mvim
fw and legal fcs.Me Al Met ll legal Also will d fled ad head in BOOM calcium.
Both the Client sad as Perin ble Party am jointly and awasaly responsible for all
charge,Imenlev proNded by ABC.
.ABC will make anilable to its retortion, meu reprtsmlause erNOr mast BanrLism
Information about Me service voila am being perfumed(m Climt,psymmts and Other
Mannou[ion About Me ektimship beMxm Client and ABC. If is infomutioo will be used _
solely fm Me simple,of a nslunu ng ABC's pef ee of is abligato,under in aantlrise
specimens. Client and Me Respme ible Party commt ho dicanome of Mis in(omutim in Me
manner and for Me Purpose deambd above. -
Chmg,orCaumndam.fgm&,: Twm[y-((za)nmrr nmin is rtynird feeallehengea -
.W. ctlleMor. Canw,usian wubaN a U-ham notice will moult in Uug,for hmrs At
xhduld.ABC come Me rip]re fishes]solo u enY time,pmvitlin8 eppliuble entice, _
mquimE by low.Whan a amp in Crogiver is odviablei or you have a schdulirtg ehenge(e.g.
form or Ire home needed,evil]needs chanec promenades Ale cot compeLllic.di Please call
ABCtoemu,te Nan&.Yom.au,twillbehandledeppo dodyby Nes ffingdmutmmt
Aidem r Camgivm w required to 1.Me eaR g deyuo and know of my Nanges,by
infmsid.,"Cdirta'ely YOm change willMPmr'.esad inithruly foam— -
Valuables:For your Protection.It is recommended Met you,or your Pooily,iro may all highly
valued irons in your home prior to wrom mcentmn of setviw by ABC employees.eM Ploee
them in a seta.1.1o1 e.g.e nfe dep,lt Mx We AMP,,k that all weapons he locked its At
all tun,.
Adminiatering Mediations: E:apt for uamem Dram,ABC emplgms are NOT pem:in d
W meridiem mudiemora.This mclWa,but is nu limited to: l)opening a praeripdon bonle;
admirestering medication N my foml(ug.removing medication from lmd,herding m you,
wiling W induce size,etc.). 2)All medication houa are the nspurodbllitY of the Client
including au ing¢countyofthe type.dosage and fm,,meny fwiW Me exception ofrtmmdea)
ofteedication.))ABCmay only give verbal rtminders mNOr observe medications being Mtm.
Cluva: For me ufery and rejection of me Clients and 9eF,ABC emomee our nnN to wev
glove whenever performing my rype of cart. At Out Xvn of cart,we will supply a[ox of
gloves.If you Veld,you may supply yon awn gloves.
•M'ps Baton NtlxmpYMe Plu
eo-npuf Yanmmodl fAnl Srrvkalprm,rnl.sum¢.NOam-ABC MN4nb]namill e
GIfWGntulry: We Mprecime when a Client is suisGed with tie service uur nrt pmviders
give. We uk Nm you let our we providers kwon you art happy witM1 Ne.,,ice they he-
provided,and if,mabl,come a ratimoniel lamer about the smciw you have reuivec;however
,less,do nW give my gifts. Cart providers—smelly frohibiW from aeccprirg any tYPe of
,reluil
Me bin read,understand,and spree to all oflhe above fOrtnad Information.
<mn, c��i�
ABC ReP uXVe cat arRaPavalple Parry
S:pyaturt
fort fsm.! .�-_ {!r d' ',,at-
Title Client or RCPonelble Pxrry
(Print Name)
Date Date
Arens Bel 4n ertlrc Yl,Oanh VN,]N)
eunpnrl COnl . CIMn.GrkaA,amm.SONnMaY➢4P"ABC YMarM)Mgrl eal
Soutfirake
\\7
OUTL A G E Pwident care
.,._. .� �. �:. . Program 7,j. r,,
Service Order Form
Name MarA 0611_.1
Address Ida C" Rd APk IDs
phone q11- 7qq' 0449 (631 G IIA.,d A22-92f�)
Rm,umal ror PBlSnnaRild SWice Cdr¢SCiledwe
Rem,rlmeefea itec'- F m
Wake no 411 ✓ LL
Brmdng/Grooming Day ✓ ✓
Med Reminder Mom ✓
BeN/Drtssing/ ..g ✓
Escort W BteaHas...V Raom Yrvi,e
Please cat[us anytime for answers to your
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or to update your address 8 phone number. Beginning May 04, 2012
through June 05, 2012
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or to update your address&Phone number. Beginning June 06,2012
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information,anent rates,and answers to OF 6
your questions.
Beginning JuLy06, 2012
through August 03, 2012
Inages for account XXXXXXX013-4
4533 4635
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0036046150{ 61006801361 6H51. 1:036076L50t: 6i00680136r 6655
4654 07124,2012 $50.00 4655 07127/1012 $204.31
Mm6>FDIC Q Epnl Mdtlp tmtler
"I� A. Settlement Statement (HUD-1)
' • ��Y 0t•d�
B. Type of Loan
1.Q FHA 2.Ej RHS 3.❑X Conv.Unins. 6. File Number. 7. Loan Number. 8. MoM1gage Insurance Case Number:
4. VA 5.0 Canv.ins. 71-000338-13 503802900 571-1195006-703
C. Note: This loan IS lumfshed to give you a statement a/ecfual settlement costs. Amounts paid to and by are'safflement agent em shown.
Items marked'(p.o.c)'wen,paid outside the dosing:they am shown hem lorinlonnallonal purposes and am not Included In the tariffs.
D. Name and Address of Borrower: E. Nam and Address of Seller. F. Name and Address of Lender.
Mark E.Kerns Clare R:Clelland Flagstar Bank,FSB
406 Pine lake Estates 306 Clark St. 5151 Corporate Drive
Fairmont,WV 26554 Fairmont.WV 26554 Troy,MI 48098
G. Property Location: H. Settlement Agent: 1. Settlement Date:
306 Clark St. Samuel L White,PC
Fairmont.WV 26554 601 Morris St.,Suite 400 ApH129,2013
Marion County,West Vlglnlo Charleston,WV 25301 Ph. (304)413-0010
Place of Settlement
513 Faim ant Ave. .
Faimgnl.WV 26554
J. Summary of Borrower's transaction K. Summary of Seller's transaction
100. Gross Amount Due from Borrower. 400. Gross Amount Due to Seger.
101. Contract sales prim 76000.00 401. Contract sales rice _ _ 76,_0.00.0.0
102. Personal roe 402. Personal property
103. Settlement Charges to Borrower Line 1400 3 574.88 403.
104. 404.
105. - 405.
Atl ustments for Items paid by Sella,In advance Atl ustments for Items paid by Seller In advance
106. CI /Town Toxes to 406.CI /Town Taxes to
107. CountyToxes to 407.County Taxes to
108. Assessments to 408.Assessments to
109. 409.
110. - 410.
111. 411.
112. 412.
120. Gross Amount Due from Borrower 79,574.88 420.Gross Amount Due to Seller 76.000.0(
200. Amounts Paid by or in Behalf of Borrower _ 500. Reductions In Amount Due Seiler:
201. Deposit or earnest Tone 500.08 501. Excess deposit see Instructions)
202. Principal amount of new loans 74 623.00 502. Settlement cha es to Seller Line 1400 4,877.8
203. Existing loans taken subject to 503. Existing bans taken subject to
204. 504.Payoff First Mortgage
205. 505.Psych Second M.or ae
206. 506.
207, 507.(Deposit disb.as proceeds)
208. Seller Paid Closing Costs 2,431.00 508,Seller Paid Closing Casts 2 431.0,
209. Closing cost Paid by seller 69.00 509.Closing cost aid by seller _ _6.9._01
Ad ustments for Items unpaid by Seller Adjustments for Items unpaid by Seller
210. Cityrrown Taxes to 510.CI /Town Taxes to
211. CountyTaxes 01/01113 to 0429113 157.85 511.County Taxes 01/01113 to 0429/13 157.8".
212. Assessments to 512.Assessments to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518,
219. 519.
220. Total Paid b lfor Borrower 1 77,780.85 520. Total Reduction Amount Due Seller _ 7,535.7•
300. Cash at Settlement fromho Borrower 600. Cash at settlement to/from Seller
301. Gross amount due from Borrower line 120 79 574.68 601. Gross amount due to Seller line 420 76,000.0.
302. less amount aid b ttor Borower line 220 ( 77,780.85) 602. Less reductions due Seller(line 520 ( 7.535.7
303. Cash O From To Borrower 1,794.03 603. Cash ❑X To From Seller 68,464.21
The undersigned axbenv.x4e1.owled a rece wvke.pxny(rl
The undersigned Aereb�y�a�\nowletlge receipt of a mpleled copy of This statement any attachments referred to herein _l
Borrower I 1 ' 9 Seller (�Qahs.. �1, U'zlo,e.(
Mark E. e- m7777�1���1TT���� Clara R.Clelland
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m�pvi.eaa mm+.m�q.rt. pv.a demrnm� nnme�HOmeeera�xnnx.ao+a4.gmve new r_trxn4npeamwwe.m'"'ro.alror m.n so. wY.�nwn.
AxYd M t.0emenl Pwtn
Page 1 of 3 HUD
(71-000338-13.PFD21-000338-132
REV-1513 EX.(01-10) SCHEDULE J
pennsylvania
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
CLARA R. CLELLAND 21-13-1003
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under
Sec. 9116(a)(1.2).]
1. KENNETH P. CLELLAND SON 50 %
130 OLD STONE HOUSE ROAD
CARLISLE, PA 17015-9771
2. WILLIAM B. CLELLAND SON 50 `&
124 LOYD COURT
LEXINGTON, SC 29073-7142
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. $ 100 %
If more space is needed, use additional sheets of paper of the same size.
3W46AI 1.000
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LAST WILL AND TESTAMENT
OF
CLARA ROSEMARY CLELLAND
t� I, CLARA ROSEMARY CLELLAND, of the City of Fairmont,
Marion County, West Virginia., being of sound and disposing mind and
understanding, do hereby revoke all forms of wills, codicils, as well as
other instruments of testamentary nature, heretofore made by me, and do
hereby make, publish and declare this writing to be my last will and testament
in manner and form following: '
FIRST: I direct my Executor, hereinafter named, to pay
out of my estate all of my just debts, funeral expenses and costs of the
administration of my estate. I further direct that all estate and inheritance
-taxes, and other governmental charges assessed by reason of my death, be
paid out of the residue of my estate, without seeking reimbursement from or
charging any person for any part of the taxes and charges so paid.
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SECOND: After the payment of my just debts, taxes and '
funeral expenses, I give, devise and bequeath all of the rest, residue and }
!, remainder of my property, of whatsoever kind and nature, and wheresoever
situate or being, of which I may die seized or possessed, or to which I may
!3 be entitled at the time of my death, unto my beloved husband, Kenneth Paul
4 Clelland, absolutely and in fee simple, to the express exclusion of all my j
children.
THIRD: In the event that my said husband, Kenneth Paul
Clelland, shall predecease me, or in the event that my said husband and I 3
shall perish in a common accident or catastrophe, or disaster, or if he dies i
within a period of thirty (30) days after my death, then, and in either of said
events, I give, devise and bequeath such entire rest, residue and remainder }
of my estate,otherwise going to my said husband under paragraph "SECOND" i
above, unto my beloved sons, namely, Kenneth Paul Clelland, Jr. and i
William Bailey Clelland, in equal undivided shares, share and share alike,
absolutely and in fee simple forever.
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FOURTH: I nominate, constitute and appoint my said husband,
Kenneth Paul Clelland, Executor of this my last will and testament. In the i
event of his death, or refusal or inability to act, I hereby nominate and
appoint my sons, Kenneth Paul Clelland, Jr. and William Bailey Clelland, to
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;-
CLARA ROSEMARY CLELLAND
act as successor Executors of this my last will and testament, and I direct
that no bond or undertaking shall be demanded or required of my husband or
sons on their official bond as Executors of my estate.
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FIFTH: I hereby expressly empower my said Executor, if
and whenever, in the settlement of my estate, he may deem it advisable, at
his discretion, to mortgage or sell any part or all of my real or personal
property, at public or private sale, and on such terms and conditions, an d
for such consideration as he deems for the best interest of my estate, and to
execute, acknowledge and deliver all deeds, instruments of transfer and all
iother writings necessary to pass a proper title thereto to any purchaser or
purchasers or mortgagees.
SIXTH: I hereby request the attesting witnesses hereunto to
make and subscribe an affidavit to be attached hereto in accordance with the
provisions of Section 15, Article 5, Chapter 41, of Michie's 1966 Annotated
Code of West Virginia, for the purpose of proving this will when the same is
offered for probate.
IN WITNESS WHEREOF, I have on this , 1 'day of October,
1972, signed, sealed, published and declared the foregoing instrument as and
for my last will and testament, in the presence of each and all of the sub-
scribing witnesses, each of whom I have requested in the presence of each
other, to subscribe his name (with his address), as an attesting witness, in
my presence and in the presence of the other.
f/IiF t�, /pliyLtw /�D�. / SEAL)
TESTA IX
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The foregoing instrument, consisting of two (2) pages, in- !
cluding this page, was subscribed, sealed, published and declared by Clara
II Rosemary Clelland, the testatrix therein named, as and for her last will and
�Itestament, in the presence of each of us, who at her request, in her presence'
and in the presence of each other, have hereunto subscribed our names as
witnesses the day and year hereinbefore written.
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ITNESS ADDRESS
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STATE OF WEST VIRGINIA,
COUNTY OF MARION, TO-WIT:
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I This day personally appeared before the undersigned author-
ity, /if,, C — and if/.✓ U/1u S
who, being first duly sworn, upon their oath depose and say: That we are the
attesting witnesses and were present on the.&,°day of October, 1972, at the
execution of the last will and testament of Clara Rosemary Clelland, hereunto i
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annexed; that we saw the said testatrix sign said will, and heard her publish
and declare the same to be her last will and testament; that we subscribed {
our names as witnesses to said will at the request of said testatrix in her
I
presence, and in the presence of each other, all being present at the same
time. We further depose and say that at the time of the execution of said will j
the said testatrix was above the age of eighteen years; a resident of Marion
County, that she was of sound mind and memory, and that she was under no
1 restraint. We further depose and say that this affidavit is made at the express
request of the said testatrix in her presence during her lifetime, to be used
} as evidence upon the proof of said wil en 3 e is ffered f obate,
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Taken, subscribed and sworn to, before the undersigned
authority, in Marion County, West Virginia, this the &7-day of October,
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1972.
3.
Notary Public i. and for arion County,
est Virginia
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My ommissi fires: �
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