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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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GROVE SYBILLA E.
DATE OF DEATH (MM-DD-Yearl
DATE OF BIRTH (MM-DD- Year)
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02/03/2005 08/19/1911
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAl)
FILE NUMBER
2 1 -0 5 0 1 2 9
COiJNlYCOoE --VEA;r- - - 'NUMs'ER--
SOCII\L SECURITY NUMBER
187-50-0084
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return (date llldeatll prior tn 12-13-S2)
o 5. Federal Estate Tax Return Required
lL 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (AttachSch (
1XI1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (A1IachcopyclWill)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (datellldea1h after 12.12.82)
o 7, Decedent Maintained a Living Trust (AlIachcopy lllTrust)
o 10. Spousal Poverty Credit (dale llldeath belween 12-31.91 and 1-1-95)
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TELEPHONE NUMBER
717 432-4514
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(2)
(3)
(4)
(5)
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IX:
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly OWned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
(6)
(7)
(9)
(10)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
X _(15)
50,442.31 X ~(16)
X .12 (17)
X .15 (18)
(19)
16. Amount of Line 14 taxable at "neal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
<~Slr${DE:ANO.RE HeCKMA1H <, <
PA 17019
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34,704.29
22,552.74
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57,257.0
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6,152.69
662.03
(11)
(12)
(13)
6.814.7
50,442.3
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(14)
50,442.~
2,269.!
2,269.
Decedent's Complete Address:
STREET ADDRESS
911 Grantham Road, Box 104
CITY I STATE I ZIP
Grantham PA 17027
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
$2.269.90
$1.794.02
$94.42
Total Credits (A + B + C)
(2)
$1,888.44
3. InteresUPenalty if applicable
D. Interest
E. Penalty
T otallnteresUPenalty ( 0 + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check AGENT
$0.00
$381.46
$0.00
$381.46
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; ........................................................................... 0 1&1
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 1&1
c. retain a reversionary interest; or ...................................................................................................... 0 1&1
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 1&1
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?............................................................... ..... .......................... 0 1&1
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. 0 1&1
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 0 1&1
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct
and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING R TURN DA
ADDRESS
For dates eath on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. ~9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ji)).
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)J.
Thi"\ t",v ............ ill'"u.\.....~n,.a ....." +hn "'". ""''',''' ....f= "..",nto",".."" +,... "'.. .f:nr +hn 'Ir-,... .....f fh..... "'.........."'....""'".',.. I:",",,,' h""',,/i.....:"'..i....o
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111e: lel^. lale 11ll}JV~OU UIIlItC II~l VOIUt:: Vlllall~ICI:;' lUUI IVI lilt:: U~CUlllICUe:l.ol::;Ut;lll;) IlIlCQI UvllCllvICUIt:i;:) 1"......\.110, C^"",t;tJlO" IIULCU nllL. r.v. 'j.-:lIIV\I.L}
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The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
'REV-1508'EX + (6-98)
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SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
GROVE. SYBILLA E.
FILE NUMBER
21 05
Indude 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.
0129
ITEM
NUMBER
1.
3.
4.
5.
6.
7.
8.
9.
10.
11.
DESCRIPTION
PNC BANK, NA - Certificate of Deposit no. 31500229326
PNC BANK, N.A. - Certificate of Deposit no. 31500218646
CITIZENS BANK - Certifcate of Deposit no. 6140634353
CITIZENS BANK - Certificate of Deposit no. 6140789443
CITIZENS BANK - checking account no. 6100742911
CITIZENS BANK -Interest check from CD#6140634353
CITIZENS BANK - interest check from CD#6140789443
PNC BANK, NA - interest check from CD#31500229326 and CD#31500218646
Capital Blue Cross - health insurance claim
Capital Blue Cross - health insurance claim
VALUE AT DATE
OF DEATH
$5,009.21
$5,009.21
$9,000.61
$8,001.30
$7,441.25
$20.11
$18.8E
$19.7(
$101.8;
$82.1!
TnT^L (^Is" ""t". "n I;"" J:: O""ap','u'nt'lon) ~
IVII"\ .n V'OIICIV IIIIC"",I'\CI"" l fa I"
(If more !/pace is needed, insert additional sheets of the same size)
34,704.:
o PNCBAN<
February 23, 2005
Jane Alexander
Attorney at Law
148 S Baltimore St.
Dillsburg, P A 17019
scp
RE: Estate of Sybilla E Grove (Deceased)
SSN: 187-50-0084
DOD: 02-03-2005
Dear Ms. Alexander:
In response to your request for Date of Death balances for the customer noted above, our
records show the following:
Certificate of Deposit
Account #31000250166 Established 12-15-2004
SYBILLA E GROVE
AQUILLA R LICK
DOD balance: $10,021.57 + $12.85 accrued interest
Account #31500218646 Established 09-5-2001
SYBILLA E GROVE
DOD balance: $5,000.00 + $9.21 accrued interest
Account #31500229326 Established 06-05-2002
SYBILLA E GROVE
DOD balance: $5,000.00 + $9.21 accrued interest
Please note that this office only provides date of death balances for deposit accounts
(IRAs, CDs, Checking and Savings accounts). We do not process any financial
transactions or provide statements. If you need assistance with any of these items,
please call1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch
office.
Sincerely,
~ :J ,~y
Erica L Schlegel
1-800-762-1775
P7-PFSC-04-F
500 First Ave.
Pittsburgh PA 15219
Member FDIC
.~ CITIZENS BANK
Account Number 6140694353
Account Title SYBILLA GROVE
Date Opened 2/1/95
Account Type Time Deposits
Principal Balance as ofDOD $9000.00
---.---...
Interest from Last Posting to DOD $.61
Account Balance as of DOD $9000.61
YTD Interest to DOD $37.76
.~ CITIZENS BANK
Account Number 6140789443
Account Title SYBILLA GROVE
Date Opened 3/1/01
Account Type Time Deposits
Principal Balance as of DOD $8000.00
-
Interest from Last Posting to DOD $1.30
Account Balance as ofDOD $8001.30
YTD Interest to DOD $40.17
.~ CITIZENS BANK
Account Number 6100742911
Account Title SYBILLA GROVE
Date Opened 10/4/77
Account Type Checking
Principal Balance as ofDOD $7441.25
Interest from Last Posting to DOD
Account Balance as of DOD $7441.25
YTD Interest to DOD $.00
. REV-150g EX + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
GROVE. SYBILLA E.
FILE NUMBER
21
05
0129
If an asset was made jOint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. Aquilla R. Lick
911 Grantham Road, Box 104
Grantham, PA 17017
Daughter
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JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTL V-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENl'SINTERES
1. A. 12/15/2004 PNC BANK, N .A. - Certificate of Deposit no. 31000250166 $10,034.42 100. $10,034.4L
2. A. Members 1st Federal Credit Union - Savings account no. 130002 $12,518.32 100. $12,518.3L
(balance as of 12/31/2004)
TOTAL (Also enter on line 6, Recapitulation) $ ')1"') ~E= "?J
(If more space is needed, insert additional sheets of the same size)
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MEMBERS 1st
FEDERAL CREDIT UNION
REGULAR SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
Date Joint Ownership Established
130002 -00
12/02/1992
$12,528.95
$.69
$12,529.64
Aquilla R. Lick
12/02/1992
MFjBERS 1ST ~E.. ~AL ~R. EDIT UNION
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'Denise A. Wolfe /
Insurance Services Supervisor
March 18, 2005
Estate of: SYBILLA E. GROVE
Date of Death: 02/03/2005
Social Security Number: 187-50-0084
5000 Louise Drive . Po.Box40 · Mechanicsburg,Pennsylvania 17055 . (717) 697-1161 . www,members1st.org
'REV-1511 EX+ (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
GROVE SYBILLA E
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21
05
0129
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Cocklin Funeral Home - funeral $530.70
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Repnesentative (s) Frances E. Kunkle $883.33
Social Security Number(s)/EIN Number of Personal Repnesentative(s) 185281211
Street Addness 5421 Paradise Road
City Dover State PA Zip 17315
Year(s) Commission Paid: 2005
2. Attorney Fees Jane M. Alexander, Esquire $2,650.00
3. Family Exemption: (If decedenfs address is not the same as daimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Register of Wills $132.00
5. Accountanfs Fees
6. Tax Return Preparer's Fees $100.00
7. Tina M. Burkey - witness fee $25.00
8. Register of Wills - filing inheritance tax return and Inventory $25.00
9. Halvard E. Alexander - notary fees $30.00
10. Register of Wills - filing release $10.00
TOTAL (Also enter on line 9, Recapitulation) $ 6152.69
(If more space is needed, insert additional sheets of the same size)
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
GROVE, SYBILLA E.
Decedent's Name
Page 1
21 05 0129
File Number
Schedule H - Funeral Expenses & Administrative Costs - 81
ITEM
NUMBER DESCRIPTION AMOUNT
B. ADMINISTRATIVE COSTS:
Personal Representative's Commissions
2. Name of Personal Representative (s) AQuilla Lick $883.33
Social Security Number(s)/EIN Number of Personal Representative(s) 199342578
Street Address 911 Grantham Road. Box 104
City Grantham State PA Zip 17027
Year(s) Commission Paid: 2005
3. Name of Personal Representative (s) Darvin J. Grove $883.33
Social Security Number(s)/EIN Number of Personal Representative(s) 210326154
Street Address 22 Tannery Road
City Dillsburll State PA Zip 17019
Year(s) Commission Paid: 2005
.,.,
SUBTOT AL SCHEDULE H.B1 $1,766.66
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REV-1512 EX + (6-98)
*'
SCHEDULE'
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
GROVE. SYBILLA E.
FILE NUMBER
21 05
0129
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
VALUE AT DATE
OF DEATH
1. Neighborcare Pharmacy Services, Inc. - expenses of last illness
$17.28
2. HCR Manor Care - expense of last illness
$534.75
3. Guistwite Family Practice - expense of last illness
$110.00
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
662.0~
. "V-"""'w
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
GROVE SYBILLA E. 21 05 0129
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
1. TAXABLE DISTRIBUTIONS [Include outright spousal distributions. and transfers under
Sec. 9116 (a) (1.2)]
1. Frances E. Kunkle Daughter 1/5 residue
5421 Paradise Road
Dover. PA 17315
2. Sherman Grove Sone 1/5 residue
106 Pine Ridge Road
East Berlin. PA 17316
3. Leon Grove Son 1/5 residue
7160 Carlisle Road
Dover, PA 17315
4. Aquilla Lick Daughter 1/5 residue
911 Grantham Road, Box 104
Grantham, PA 17027
5. Darvin J. Grove Don 1/5 residue
22 Tannery Road
Dillsburg, PA 17027
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
n. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1. None $0.00
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. None $0.00
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ a.O(
(If more space is needed, insert additional sheets of the same size)
last Bill anh Q}t$tamtnt
of
SYBILLA E. GROVE
I, SYBILLA E. GROVE, of the Borough of Dillsburg, County
of York and Commonwealth of Pennsylvania, being of sound mind,
memory and understanding, do hereby publish and declare this
to be my Last Will and Testament, hereby revokir,g and declaring
null and void any and all Wills and Codicils heretofore written
by me.
ITEM 1.
direct that all my just debts and funeral expenses
be paid as soon after my demise as may be convenient to the proper
administr~tion of my estate.
ITEM II. All the rest, residue and remainder of my estate,
of whatsoever nature and wheresoever situate, I give, devise
and bequeath unto my children, Frances E. Kunkle, Aquilla Lick,
Leon Grove, Sherman Grove and Darvin J. Grove, in equal shares-
per stirpes and not per capita.
ITEM III.
order and direct my hereinafter named Execlltors
to pay all estate and inheritance taxes prior to further distri-
bution of my estate.
ITEM V.
I nominate, constitute and appoint Frances t. Kunkle,
Aquilla Lick and D~rvin J. Grove, Or the survivor of th~m, as
Execlltors of this, my L~st Will and Te"tament.
direct that
my "aid Execu~ors shall not be required to post bond other than
their personal assurance for their duties as Executor.
IN WITNESS WHEREOF, I, SYBILLA E. GROVE, have hereunto sub-
scribed my hand to this my last Will and Testament, this ~
day of
/)1 (J 0
, 1982.
~-&a. [, ~~'-~
Sy lla E Grnve
SIGNED, PUBLISHED and DFCLARED by the Rbove named SYBILLA E.
GROVE, as Rnd for her Last Will and Testament in the presence
of us, who at her renuest and in her presence and in the presencA
~f ~ach other, have signed our names as ottesting witnesses hereto.
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