HomeMy WebLinkAbout03-18-15 (2) ��' pennsylvania 15 0 5 618 4 0 3
DEYARTMENTOF REVEN
�X(03-14)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes Counry Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN
HarrisburQ,PA 17128-0601 RESIDENT DECEDENT 21 14 0 6 5 3
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
06 25 2014 08 07 1946
DecedenYs Last Name Suffix DecedenYs First Name MI
GRIMES MARY J
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Su�x Spouse's First Name M�
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
a1. Original Return � 2. Supplemental Return � 3. Remainder Return(date of death
prior to 12-13-82)
� 4. Agricultural Exemption(date of � 5. Future Interest Compromise(date of � 6. Federal Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82)
� 7. Decedent Died Testate � 8. Decedent Maintained a Living Trust 9. Total Number of Safe Deposit Boxes
(Attach copy of will) (Attach copy of trust.)
� 10. Litigation Proceeds Received � 11. Non-Probate Transferee Return � 12. DeferrallElection of Spousal Trusts
(Schedule F and G Assets Only)
� 13. Business Assets � 14. Spouse is Sole Beneficiary
(No trust involved)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
SEAN M SHULTZ 717 243 6222
First Line of Address
26 W HIGH STREET
Second Line of Address
City or Post Office State ZIP Code
CARLISLE PA 17013
CorrespondenYs email address: dhockenberry(a�ssr-attorneys.com
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REGISTER OF WILL�SE ON ' �
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REGISTER OF WIILS USE ONLY �'� �
DATE FILED MMDDYYYY 7 _�vi _-�i - '
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DATE FILED ST'A7�7P ''
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Side 1
� I �'II II'II�IIII��II)�IIII'll'I II��I IIIII'I�II�I I'IIII IIII
15056184�3 1505618403 �
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� 1505618411
REV-1500 EX DecedenYs Social Security Number
Decedent's Name: G�Ifll@S, Mary Jane 2 0 2 3 6 5 7 9 2_
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1.
2. Stocks and Bonds(Schedule B)............................................................................. 2.
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3.
4. Mortgages and Notes Receivable(Schedule D).................................................... 4.
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).......... 5. 4 0 2 ,8 3 3 - 0 0
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7 ,5 6 4 - 15
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested............ 7. 2 0 2 ,7 5 4 • 7 0
8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 613,151 • 8 5
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 15 , 4 5 2 - 7 8
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10. 41 • 0 6
11. Total Deductions(total Lines 9 and 10)................................................................ 11. 15 , 4 9 3 • 8 4
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 5 9 7 ,6 5 8 • 01
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. 5 9 7 ,6 5 8 - 01
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.00 15. 0 • 0 0
16. Amount of Line 14 taxable
at lineal rate X .045 5 9 7 ,6 5 8 • 01 16. 2 6 ,8 9 4 - 61
17. Amount of Line 14 taxable
at sibling rate X.12 0 • 0 0 1� ❑ • 0❑
18. Amount of Line 14 taxable
at collateral rate X.15 0 - 0 0 18� 0 - 0 0
19. TAX DUE................................................................................................................ 19. 2 6 ,8 9 4 - 61
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT �
Under penalties of perjury,I declare 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 person responsible for filing the return is based on all information of which preparer has
any knowledge.
I NATURE OF ER�R SP NSIBLE FOft FILING RETURN Kimberly Sue Wickard � DATE'
�_ ,� l�s
AD ESS
1 4 Kerrs oad, Carlisle, PA 17015
SIGNAT�E OF PR�EPARER 0 R THAN REPRESENTATIVE Sean M. Shultz DATE
,'`_�/� c �/7//`J
ADDRESS
26 W. High Street, Carlisle, PA
I I��I�I II�II�IIII�II�I IIII�IIIII II�II I�III II��I(II�I IIII IIII Side 2
� 15U5618411 1505618411 �
PA Inheritance Tax Return
Signature of Additional Fiduciaries
ESTA7E OF �ILE NUMBER
Grimes, Mary Jane 21-14-0653
Under penalties of perjury,I daclare 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 fs based on all
information of which preparer has any knowledge.
' Signature#2 � � ��
' Nama Wfllfam Edward Grimes Jr.
Address1 364 Bur ners Road
� Address2
Clty, State,Zlp Carlisis PA 17015
Date � '� �
� `/� �
Signature#3 J � � �
fj
Name �a h Daniel Grimes
Addressl 117A Newville Road
Address2
�
Clty,Staf�,Zlp Garlisle PA 17013
Date —����
i
�
REV-1500 EX Page 3 File Number 21-14-0653
Decedent's Complete Address:
DECEDENT'S NAME
Grimes, Mary Jane
STREET ADDRESS
538 Opossum Lake Road
CITY STATE ZIP
Carlisle PA 17015
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 26,894.61
2. Credits/Payments
A. Prior Payments 24,000.00
B. Discount 1,263.16
Total Credits(A +B) (z) 25,263.16
3. Interest �3�
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. �q�
Check box on Page 2,Line 20 to request a refund
5, If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) �,631.4rJ
Make Check Payable to REGISTER OF WILLS, AGENT
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, ., �,�.,,., v.,..�t,�,.> x........a
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
b. retain the right to designate who shall use the property transferred or its income:.................................. ❑ ❑x
c. retain a reversionary interest;or............................................................................................................... ❑ ❑X
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?.................................................................................................................... x
3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... ❑ �x
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.
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For dates of death on or after July 1,1994 and before Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is 3 percent(72 P.S.§9116(a)(1.1)(i)].
For dates of death on or after January 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)]. The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an
adoptive parent,or a step-parent of the child is 0 percent[72 P.S.§9116(a)(1.2)j.
• The tax rate imposed on the net value of transfers to or for the use of the decedenYs lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)].
. The tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is 12 percent[72 P.S.§9116(a)(1.3)]. A sibling is defined,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
Rev-�508 EX+(08-12)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
INHERITANCETAXRETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Grimes, Mary Jane 21-14-0653
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 2004 Chevrolet Blazer-Sale Proceeds 8,500.00
2 Dresser-Sale Proceeds 100.00
3 Income Tax Refund-2014 1,675.00
4 M&T Bank Checking Account#2679023909-See attached letter from M&T Bank dated 1,442.64
August 5, 2014
5 M&T Bank IRA Account#35004200211908-See attached letter from M&T Bank dated August 2,332.04
5,2014
6 M&T Bank Savings Account#25004920099379-See attached letter from M&T Bank dated 1,617.68
August 5, 2014
7 Refund from Adams Electric 948.34
8 Refund from Adams Electric 221.48
9 Refund from Erie Insurance-home owners insurance 210.00
10 The Hartford Annuity#710970263-See attached letter from The Hartford dated August 5, 217,948.91
2014
11 The Hartford Annuity#710970632-See attached letter from The Hartford dated August 5, 167,836.91
2014
TOTAL(Also enter on Line 5, Recapitulation) 402,833.00
(If more space is needed,additional pages of the same size)
Copyright(c)2012 form software only The Lackner Group,Inc. Form PA-1500 Schedule E(Rev.08-12)
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4991vtitche3l Road,Mil(sboro,DE 19966 Records ManAgement
Phone 888-502-4349
F ax (302)93A-2955 �
August5,201A �
Law Officea Of �
Saidis,Sullivan &Rogers �
26 West High Street ;�
Carlisle,PA 17013 a
�
�
�
Re: Estate of Mary Jane Grimes '
Social Securitv: 202-36-5792 �
Date of Dea#h: June 25,2014 �
;
�
Dear Sir or Madam: �
Per your inquiry on July 23,20�14,please be advised that at the time of death,the abov�named decedent had on
deposit with this bank the following: '
1. Type of.�ccount Checkingflccaunt
Account Number 2679023909
Ownership(Names of) Mary J. Grimes
Ope»rng Date 07/OII1994
Balance on Date of Death S' 1,442.63
Accruedlnlerest $ .01
_.__....__.._.,_....._.._.__.----_...,--•----------------�..-----
Total $ l,442.64
2, 7j�pe ofAccaurri Individual RetirementAccount
Accaunt Number- 35004200211908
Ownership(Names o}} Mc�y J.Grrmes
Opening Date 02/23/1999
Balance on Date of Death $ 2,33�.92
,4ccruedlntei-est $ 1.12
..___.__....._...�.�._._.....____.----......_...__......_,..____..._.......
Total $ 2,332.09
3. Type of.4ccount Savings Account
Account Number 25004920099379
Ownerslu'p(Names o,�} Mary J.Grimes
Opening Date 10/04/1983 ,
A
Balance on Date ofDeath $ 1,617.61 j
Accrued Interest $ .07
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._�....._...----.__.___..__...__�_.._._.._._ . . _ . �
Total $ 1,61�.68 .-.---_.._._._._
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For xny additlonal informa6oM on the abo�e accounts,including ownership and seoy changes;closures andlor reimbursemeat of funds, �
please exll the High Street Carlisle at 717 240-4536.
�
We were unabEe to locate any safe depoait box for the ahove-menNoned decedent. ,
� This letter does not indudc any accounfs in which the deceased may have been listed as Powcr of Attorney,Cavtodian of Uniform Transfers, ;
RepresentetivcPayee,or Tivstee under a Written Agreement
Sincerely, ,
Valarie Mercer '
Recorcfs Management
i '
Aug � ZB14 16;18:43 EDT �� F2M/Z5541TZ6879 17S[� 7.]87].55S—BB6-1 PAGE 8BZ DF 88Z
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Rev-1509 EX+(01-10)
pennsylvania SCHEDULE F
DEPARTMENTOFREVENUE �OINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Grimes, Mary Jane 21-14-0653
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. Kimberly Sue Wickard 164 Kerrs Road Daughter
Carlisle, PA 17015
B, Joseph Daniel Grimes 1174 Newville Road Son
Carlisle, PA 17013
Ca William Edward Grimes,Jr. 364 Burgners Road Son
Carlisle, PA 17015
JOINTLY OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECD�S VALUE OF
NUMBER NUMBER OR SIMILAR IDENTIFYING NUMBER.ATTACH DEED FOR VALUE OF ASSE DECEDENT'S INTEREST
TENANT JOINT JOINTLY-HELD REAL ESTATE. INTEREST
1 ABC 06/02/2005 Cornerstone Federal Credit Union Savings 9,614.63 25.000% 2,403.66
Account No.5556-01 -See attached letter
from Cornerstone Federal Credit Union dated
July 28, 2014
2 ABC 06/02/2005 Cornerstone Federal Credit Union Savings 20,641.94 25.000% 5,160.49
Account No.5556-07-See attached letter
from Cornerstone Federal Credit Union dated
July 28,2014
TOTAL(Also enter on Line 6, Recapitulation) 7,564.15
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule F(Rev.01-10)
CC�RN E RSTO N E p O.Box I I 8 I 5 East te Drive C '
, , ga , arlisle,PA 17015
F e d e r a I C r e d i t U n i o n Telephone (717) 249-1661 FAX (71� 249-8208
; l�Iembe�'founded—Se�'vice based www.cornerstonefcu.coop
luly 28, 2014
I
Saidis, Sullivan &Rogers
26 West High Street
Carifsle, PA 17013
! Re:The Estate of Mary Jane Grimes
Dear Sean:
� At the time of her death, Mary lane Grimes had a joint account.
Listed below is the information you requested in your letter dated July 23,2014.
1.) Account number#5556-01&5556-07
2.) Account was opened
Savings-018/09/1996
' Checicing-p7 9/11/2003
3.) Account became joint 6/2/2005
4.) Balance as ofJune 25,2014#5556-01$9,613,51
� #5556-07$20,640.56
�
S.) Interest not posted #5556-01$1.12
I
#5556-07$1.38
If you require any further information,please cal) me 717-249-1661 ext 251
� Sincerely:
�-.� � � (.rr
�v�
Cindy Willhide
Financial Service Representative
MEMBER SAVINGS ACCOUNTS FEDERALLY INSURED T� $250,000 BY THE NA7iONAL CREDIT UNION ADMINISTRATION
Rev-�570 EX+�OS-09)
SCHEDULE G
pennsylvania lNTER-VIVOS TRANSFERS AND
DEPARTMENTOFREVENUE MISC. NON-PROBATE PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Grimes, Mary Jane 21-14-0653
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECO'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFERSATTACNTA COPY OF TIHE E�ED F�OR REAL ESTATE. VALUE OF ASSET INTEREST (�F APPLICABLE) VALUE
1 Allianz Life Insurance Company Annuity Contract No. 37,856.78 100.000% 37,856.78
2721337-beneficiaries are Kimberly Wickard,William
Grimes,Jr. and Joseph Grimes-See attached letter
dated August 1,2014 from Allianz Life Insurance
Company
2 Allianz Life Insurance Company Annuity Contract No. 7.784.92 100.000% 7,784.92
2727361 -beneficiaries are Kimberly Wickard,William
Grimes,Jr.and Joseph Grimes-See attached letter
dated August 1,2014 from Allianz Life Insurance
Company
3 Life interest in property situate at 538 Opossum Lake 157,113.00 100.000% 157,113.00
Road,Carlisle, PA-See attached tax assessment of
158,700 x.99 common level ratio
TOTAL(Also enter on Line 7, Recapitulation� 202,754.70
(If more space is needed,additional pages of the same size)
Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule G(Rev.08-09)
, Ay�,�1 Z 2014
Allianz Life Insurance Company ���,��� ���
, of North America ��
PO Bpx 59060
Minneapolis, MN 55459-0060
800,950.1962
August 1, 2014
ESTATE aF MARY GRIMES
C/O SEAN SHULTZ
; 26 WEST HIGH S7REET
CARLISLE PA 17013
i
I Re: Mary Grimes, deceased
� Dear Executor�
This letter is in reference to our request for information on the foilowing contract numbers:
� Annuity Contract Numbers 2721337 2721361
Palicy l�aie 07/09/1993 �7/09/1993
Tax Shelt�r St�tus Non-Tax-QUalrfieci Non-Tax-Qualitied
Annuitani Name Mary Grfines Mary Grimes
Owner Name Mary Grimes Mary Grimes
Primary Cieneficiaries Nan7e Kimberly Wickard, Kimberly Wickard,
William Grimes Jr William Grimes Jr
and Joseph Grimes and Jose h Grimes
Cost C3asis Vatue $19.000,00 $2,400,00
CaSh Surrender Value $37,F�56.78 $7,784.92
as of 06/25/2014
�
; For more information or assistance: please contact me af 800.95Q.1962, Monday through Friday, 8 a.m.to 5 p.m.
' Central time or the agent of record.
Sincerely,
Cheryl McCollam (ext 36261)
� Claims Case Manager
i
; LCL-16?_6 r.4.17.20i3
(
Property Mapper
Cumberland County, PA
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Copyrigh[2011 Esri.All rights reserved.Tue lul 1 2014 09:49:58 AM.
538 OPOSSUM LAKE ROAD
PIN:14-06-0027-041
Deedbook:201011644
Lot Description:LAND APPROX 1 ACRE
Owner:GRIMES,MARY JANE
Land Use Code:101
Property Type:R
Acreage: 1
Square Feet: 1456
Taxable Status:T
Clean&Green Status:
Assessed Land Value$:55000
Assessed 8uilding Value$: 103700
Assessed Total Value$:1587�0
Sale Price$: 1
Sale Date:Wed May 5 2010 08:00:00 PM
Year 8uilt:1970
Municipality:LOWER FRANKFORD TWP
Height in Stories:1
Type of Dwelling:DETACH
Pnmary Exterior:Vinyl
8asement Percentage: 100
Air Contlitioning:AC
Total Rooms:6
Bedrooms:3
Fult Bath: 1
Half Bath:
REV-1511 EX+(08-13)
pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
�NHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Grimes, Mary Jane 21-14-0653
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
q, FUNERAL EXPENSES:
See continuation schedule(s) attached 8,327.57
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Ziq
Year(s)Commission Paid
2. Attorney's Fees Saidis, Sullivan & Rogers 3,500.00
3. Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation)
Claimant
Street Address
City State Zio
Relationshi�of Claimant to Decedent
4. Probate Fees 343.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 3,281.71
See continuation schedule(s) attached
TOTAL(Also enter on line 9, Recapitulation) 15,452.78
Copyright(c)2013 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.OS-13)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Grimes, Mary Jane 21-14-0653
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 Cumberland Valley Memorial Gardens-Name and date marker 1,499.00
2 Ewing Brothers Funeral Home 6,828.57
H-A 8,327.57
Other Administrative Costs
3 Adams Electric 244.00
4 Adams Electric 75.19
5 Cumberland Law Journal-advertise letters 75.00
6 Erie Insurance -Car Insurance 61.00
7 Halterman's Tree Service-Tree removal 540.00
8 Jesse Wickard -Mowing 160.00
9 Pamela Burkholder,Tax Collector-Real Estate taxes 1,890.12
10 Reimbursement to Kimberly Wickard-Gas for mowers 15.15
11 The News-Chronicle Co.-advertise letters 121.25
12 Wagner's Tax Service-Income Tax Preparation 100.00
H-B7 3,281.71
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)
Rev-1512 EX+(12-12)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENTOFREVENUE MORTGAGE LIABILITIES AND LIENS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Grimes, Mary Jane 21-14-0653
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 Century Link 18.96
2 Kuhn Cable 9 22.10
TOTAL(Also enter on Line 10, Recapitulation) 41.06
(If more space is needed,additional pages of the same size)
Copyright(c)2012 form software only The Lackner Group,Inc. Form PA-1500 Schedule I(Rev. 12-12)
REV-7513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OFREVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Grimes, Ma Jane 21-14-0653
RELATIONSHIP TO
NUMBER NAME AND ADDRESS OF DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE
PERSON(Sl RECEIVING PROPERTY (Words) ($$$)
Do Not List Trustee s
I� TAXABLE DiSTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116 a 1.2
Joseph Daniel Grimes Son 1/3 residue
1174 Newville Road
Carlisle, PA 17013
William Edward Grimes,Jr. Son 1/3 residue
364 Burgners Road
Carlisle, PA 17015
Kimberly Sue Wickard Daughter 1/3 residue
164 Kerrs Road
Carlisle, PA 17015
Total
Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet,as a ro riate.
NON-TAXABLE DISTRIBUTIONS:
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10)
a:\grirnes.mj . , ,
' LAST TYILL AND TESTAIV�ENT
OF
111�AR Y,TA1 V�'G�'L11�IES
I, MARY JANE GRIMES of 538 Opossum Lake Road, Lower Frankford Township,
� Carlisle, Cumberland County, Pennsylvania, declare this instrument to be my Last Will
�
' and Testament, in manner and form following:
F1RST: I hereby expressly revoke all Wilis and Codicils heretofore made by
� me.
SECOND: I hereby direct my Executor to pay all my just debts, funeral and
administrative expenses out of my estate, as soon as practicabie after my death.
THIRD: I direct that all taxes which may be assessed in consequence of my
death of whatever nature and by whatever jurisdiction imposed shall be paid out of my
esfiate as a part of the administration of my estate.
� FOURTH: Should m� husband, WfLLIAM E. GRIMES, SR., survive i�ne by thirty
I
(30) days, I give, deviSe and bequeath all my estate, real, personal and mixed,
whatsoever and wheresoever situate, to my husband, WILLIAM E. GRIMES, SR.
FIFTH: Should my husband, Wfl.l.lAM E. GRIMES, SR., predecease me, or
shauld not be living on the thirty-first day following my death, I give, devise and bequeath
the remainder of my estate, real, personal or mixed,. whatsoever and wheresoever
situate, to thase of my children who are fiving on the thirty-first day following my death,
;,»�s�i��.Cr
a:�•imes.mj � � �
namely: WILLIAM EDWARD GRIMES, JR., KfMBERLY SUE WICKARD, and JOSEPH
DANIEL GRIM�S. In the event that any of my children are not living at that time, f give,
devise and bequeath that deceased child's share to his or her surviving child or children,
� in equal shares, share and share alike. In the event my deceased child shafl have no
child or children surviving, then and in that event, my deceased child's share shall be
divided equally among my surviving children.
;
� SIXTH: I nominate and appoint the survivars of my three children, WILLIAM
EDWARD GRIMES, JR., KIMBERLY SUE WICKARD and(or JOSEPH DANIEL
GRIMES, TRUSTEE of the share of any beneficiary who may be a minor. The income
and/or principal of said Trust may be accumulated or expended for the education of such
benefciary as my TRUSTEE, in its soie discretion, may defermine; and my TRUSTEE, in
the expenditure of incame and/or principal for such purposes, may, at their discretion,
apply the same directly or pay the same to any person having the care or control of said
beneficiary or with whom the beneficiary resides, withaut duty on the part af the
�
TRUSTEE to supervise or inquire,into the application of the funds by any person to whom
;
payment is so made, The balance of such income andlor principal of his or her share �
I
� shall be paid to such beneficiary upon reaching the age of thirty (30)years.
SEVENTH: I hereby nominate, canstitute and appoint my husband, WILLIAM E.
GRIMES, SR., to be fhe Executor of fihis my Last Will and Testament. In the event that
my husband, V1lILLIAM E. GRIMES, SR., shall be unable ta serve as Executor for any
reason, I then nominate, constitute and appoint my children, WILLIAM E. GRIMES, JR.,
initinls��j•
2
a:\gnmes.mj �
KIMBERLY SUE WICKARD, and JOSEPH DANIEL GRIMES, as Executors. No
personal representative shall be required to file bond in this or any otherjurisdiction.
IN Y�ITNESS WHEREOF, I hereunto set my hand and seal this ��h day
of - ' , 20a0.
, � CZ-r..�. �,��iG�-�..ac�
� ry Jane Grimes
SIGNED, SEALED, PUBLISHED and
DECLARED in the presence of:
.
,
� .��,' l�
� .
. initittl��J_�,7
3
a:�grimes.mj '
COMMONWEALTH OF PENNSY�VANIA .
: ss.
COUNTY OF CUMBERLAND .
I, MARY JANE GRfMES, Testatrix, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my Last Will; that ! signed it
wi(lingly; and that I signed it as my free and volunfary act for the purposes therein
expressed.
,
Sworn or affirmed to and acknowledged before me, by MARY JANE GRIMES,
� Testatrix, this e..��� day of �... , 20Q4.
! �� ta,- �i�,�
a Jane Grimes, Testatrix
, i J f.�. t �.�,�. .�
�� � r ��r
! � Notary Public
��� .
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COMMONWEALTH OF PENNSYLVANIA .
. ss.
COUNTY O� CUMBERLAND .
• We, C1�1�L J. I,INASAY and JAMES D. FLOCFIER the
,
witnesses whose names are signed to the attached or f�regoing instrument, being duly
qualified according to law, do depose and say that we were present and saw Testatrix,
MARY JANE GRIMES, 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 of us in the hearing and sight of the Testatrix signed the Will as
witnesses; and that to the best of our knowledge the Testatrix was at that time 18 or mare
years of age, of sound mind and under no constraint ar undue inffuence.
Sworn or affirmed to and subscribed to before me by CAROL J. LINDSAY and
J�s D. �zow�R , witnesses this �`�' day of� , 2000.
� itn ss
' � 1 G /!r�.J
-� . � �"L �:-/ �C.Y"� '
Witness
I
� ' ' �--�f �_�
,--
Notary Public
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