HomeMy WebLinkAbout04-06-15 1505610101
REV-1500 Ext:01-10'
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania
Bureau of Individual Taxes County Code Year File Number
PO BOX 28o6oi INHERITANCE TAX RETURN
Harrisburg,PA 17128-o6o1 RESIDENT DECEDENT 21 14 0726
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
07/09/2014 09/05/1911
Decedent's Last Name Suffix Decedent's First Name MI
KEENE CLYO 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
(31t) 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)
M 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 Sch.O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
I THOMAS E. FLOWER (717) 243-5513
REGISTER OF WILLS USE ONLY
First line of address o
FLOWER LAW, LLC C= "' �
4
Second line of address GDcz
t
M _T C_ t.
10 W. HIGH STr rw rn rn
City or Post Office State ZIP Code ;DATE l�ED
CD,C3CJ I
CARLISLE PA 17013-2922 --pq ;
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FE
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;)U r— mt
Correspondent's e-mail address: Tom@Flower-law.com -"I o r- o. t
Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowle&
JRnd 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.
SIGN PERSO SI E FOR FILING RETURN PATE
�/►1 . -/ 04/06/15
ADDRESS
FLOWER LAW, LLC; 10 W. HIGH ST., CARLISLE, PA 17013
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610101 1505610101
i
J 1505610105
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: CLYO E. KEENE
RECAPITULATION
1. Real Estate(Schedule A). .. ..... ......... ... ... .... .... ... ....... .... 1. 75,000.00
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. 16,219.37
6. Jointly Owned Property(Schedule F) O Separate Billing Requested .. ..... 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested... .. . .. 7.
8. Total Gross Assets(total Lines 1 through 7)... ..... . .. ............ .. ... . 8. 91,219.37
9. Funeral Expenses and Administrative Costs(Schedule H)...... ....... ..... . 9. 42,464.78
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) .. .. ...... . .. . 10. 919.61
11. Total Deductions(total Lines 9 and 10)...... .. ............ ...... ....... 11. 43,384.39
12. Net Value of Estate(Line 8 minus Line 11) ... ... ... .. ... ...... ... ... ... . 12. 47,834.98
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) ..... ............ ....... 13. 10,762.87
14. Net Value Subject to Tax(Line 12 minus Line 13) ......... .. ......... ... . 14. 37,072.11
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_ 15.
16. Amount of Line 14 taxable
at lineal rate X.0_ 16.
17. Amount of Line 14 taxable
at sibling rate X.12 17.
18. Amount of Line 14 taxable
at collateral rate X.15 37,072.11 18 5,560.82
19. TAX DUE ... .. ... .. ... .. .......... .. ..... .. .. ... ....... ..... .. ... . 19. 5,560.82
20, FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
1505610105 1505610105 J
REV-1500 EX Page 3 File Number 21-14-0726
Decedent's Complete Address:
DECEDENT'S NAME
CLYO E. KEENE
STREET ADDRESS
330 LONGS GAP ROAD
STATE .... - ZIP
CARLISLE PA 17013
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 5,560.82
2. Credits/Payments
A.Prior Payments _
B.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) 5,560.82
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;.......................................................................................... ❑ z
b. retain the right to designate who shall use the property transferred or its income;............................................ ❑ El
c. retain a reversionary interest;or.......................................................................................................................... ❑ 9
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?.............................................................................................................. ❑ 0
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? ........................................................................................................................ ❑
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)].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)
�pennsytvania SCHEDULE A
i DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CLYO E. KEENE 21-14-0726
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 AT 330 LONGS GAP ROAD,N.MIDDLETON TOWNSHIP,
(CARLISLE POST OFFICE)CUMBERLAND COUNTY,PA. THE HOUSE WAS SEVERELY
DAMAGED BY MOLD AND RELATED WATER DAMAGE,DUE TO A NON-FUNCTIONING
SUMP PUMP CAUSING APPROX.8 INCHES OF WATER TO ACCUMULATE IN
BASEMENT FOR AN UNKNOWN PERIOD OF TIME(HOUSE HAD BEEN VACANT FOR
SEVERAL YEARS WHILE DECEDENT WAS IN NURSING HOME). ALL GROUND FLOOR
SUBFLOORING HAD TO BE REPLACED,AND REPAIRS SUFFICIENT TO PROPERLY
MARKET THE HOME ARE NOT YET COMPLETE. A REASONABLE ESTIMATE OF THE
EVENTUAL MARKET VALUE ONCE REPAIRS ARE COMPLETE IS BELIEVED TO BE 75,000.00
TOTAL(Also enter on Line 1,Recapitulation.) $ 75,000.00
If more space is needed,insert additional sheets of the same size,
REV-15o8 EX+(ii-io)
rte'- SCHEDULE E
Pennsylvania
r, J DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
CLYO E. KEENE 21-14-0726
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. ORRSTOWN BANK CHECKING ACCOUNT#108008239 568.55
2. M&T BANK CHECKING ACCOUNT#421022 3,490.16
3. CHURCH OF GOD HOME,INC,REFUND OF OVERPAYMENT 5,550.74
4. ROWE'S AUCTION SERVICE,NET PROCEEDS OF SALE OF PERSONAL PROPERTY 205.08
5. FUNDS ON DEPOSIT,FLOWER LAW,LLC IOLTA,ORRSTOWN BANK 6,204.84
6. SALE PROCEEDS, 1984 TOYOTA COROLLA 200.00
TOTAL(Also enter on Line 5, Recapitulation) $ 16,219.37
If more space is needed,use additional sheets of paper of the same size.
FOR INQUIRIES CALL: (800)724-2440 ACCOUNT TYPE
CLASSIC CHECKING
00 0 04319M NM 017
ACCOUNT NUMBER STATEMENT PERIOD
000003663 FIDS1549D01707211407 02 010000
P 421022 JUN.21-JUL.21,2014
^t- CLYO E KEENE BEGINNING BALANCE $93.44
10 WEST HIGH ST DEPOSITS&CREDITS 3,396.72
CARLISLE PA 17013 LESS CHECKS&DEBITS 0.00
LESS SERVICE CHARGES 0.00
ENDING BALANCE'. $3,490.16
INTEREST EARNED FOR STATEMENT PERIOD $0.00 HIGH STREET-CARLISLE
ACCOUNT SUMMARY
BEGINNING DEPOSITS&OTHER CHECKS PAID OTHER DEBITS(-) CURRENT ENDING
BALANCE CREDITS + INTEREST PD BALANCE
NO. AMOUNT NO. AMOUNT NO. AMOUNT
$93.44 2 $3,396.72 0 $0.00 0 1 $0.00 $0.00 $3,490.16
ACCOUNT ACTIVITY
POSTING TRANSACTION DESCRIPTION DEPOSITS&OTHER WITHDRAWALS& DAILY
g DATE CREDITS + OTHER DEBITS - BALANCE
06/21/2014 BEGINNING BALANCE $93.44
N
07/01/2014 US TREASURY 312 XXCIV SERV $2,651.72 2,745.16
b
07/03/2014 SSA TREAS 310 XXSOC SEC 745.00 3,490.16
cI ENDING BALANCE $3,490.16
LL
O
m
YOU CAN PAY WITH YOUR M&T DEBIT CARD AT MORE PLACES THAN YOU MIGHT THINK.
n SIMPLY ENTER YOUR PIN OR SIGN FOR YOUR PURCHASE.EITHER WAY,YOU WONT PAY AN
M&T TRANSACTION FEE FOR PURCHASES IN THE U.S.,EVEN WHEN YOU GET CASH BACKI'
'M&T DOES NOT CHARGE FEES FOR USING YOUR M&T DEBIT CARD FOR PURCHASES IN THE
U.S.;HOWEVER,FEES WILL APPLY IF YOU USE YOUR CARD OUTSIDE THE U.S.,INCLUDING
ONLINE PURCHASES WITH A MERCHANT LOCATED OUTSIDE OF THE U.S. IN ADDITION,OTHER
FEES,INCLUDING INSUFFICIENT FUNDS AND OVERDRAFT FEES MAY APPLY TO YOUR DEPOSIT
ACCOUNT ACCORDING TO THE TERMS OF YOUR ACCOUNT.MEMBER FDIC.
PAGE 1 OF 1
L008(6/12)
i
ORRSTO W NBANK
A Tradition of Excellence
co
ORBS P.O.Box 250
o Shippensburg;PA 17257
Temp=Return Service Requested Date- 7/10/14 Page 1
Primary Account 108008239
Enclosures
002428 0.4500 AV 0.,381 TR00010
Clyo E Keene
% Flower Law LLC
10 W High St
Carlisle PA 17013-2922
.CHECKING ACCO U N T 'S
Account Title Clyo E Keene
Flower Law LLC
50+ Interest Checking Check Safekeeping,
Account Number 108008239 Statement Dates 6/11./14 thru 7/10/14
Previous Balance 568.55 Days In The Statement Period 30
Deposits/Credits .00 Average Ledger 568.55
Checks/Debits .00 Average Collected 568.55
Service Fee .00
Interest Paid .00
Current Balance 568.55 2014 Interest Paid 1.11
Daily Balance Information
v Date Balance
O
V' 6/11 568.55
00N
�.
N -
O
O -
Interest Rate Summary
0
6/10 0.0100000
0
0
C� THANK YOU FOR BANKING WITH ORRSTOWN BANK
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A A a
CHURCH OF GOD HOME, INC
801 N. HANOVER STREET Faun PS-01
CARLISLE,PA 17013
RESIDENT# UNITSTMT. DATE
2187 H2O9B 08/31/2014
RESIDENT(S)
JAMES D FLOWER,JR. Clyo E. Keene
FLOWER LAW,LLC ��^"
10 W. HIGH STREET TOTALAMOUNT DUE -$5,550.74
CARLISLE,PA 17013
DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE
$
---.----_---------------.___-- -- _ _. _ ---_---•_----____--___ _.__ ._ _AMOUNT REMITTED
DATE DESCRIPTION Days/ CHARGES CREDITS BALANCE
Units
Balance Forward -5,571.17
08/12/2014 Payment on account 10.57 -5,581.74
Trans from RTF
07/01/2014 Telephone-basic fee 07/08-07/08 1 31.00 -5,550.74
Please call the billing office at 717-866-3256 or 717-866-3255 with any statement questions.
All checks should be made payable to Church of God Home. Please use the enclosed envelope
to mail your payment.
RESIDENT# CURRENT OVER 30 OVER 60 OVER 90 OVER 120 AL AMOUNT DUE
2187 -5,550.74 0.00 0.00 0.00 0.00 -$5,550.74
RESIDENT NAME Clyo E. Keene s-o,
`
' -
` ~
it c- 01-0G-2Q15 13:41 :4j
Rowe" s Auction Service
2505 Ritner Highway
Carlisle, PA 17015
717-574-1008
lindenhall@aol. com
?ttlement Tom Flower 243-5513 Page: 1
?llern 16 FIower Law LLC
10 W. High St
Carlisle PA 17013
Item Qescription Price Qty otal
-------------------------------------------------------------------------------
- Karistan-style rug 1 160. 00
- Muffineer stand 4. @0
- Marble R. glass ashtray 1 12. 00
' - Nest of French stands 1 G5. N0
- Maple rocker 1 10. 00
- Pole light/marble lights
- End stands/ Rocker 1 12. 00
- Mahogany table 8 4 chairs 1 10. 00
- Pr. mahogany & leather top 1
tables
Items : 9 Amount : 315. 50
Commission at 35. 000% 110. 42
Less adjustments : -110. 42
Net due to seller: 205. �98
Thank you for your business !
ROWE'S AUCTION SERVICE 60-1503/313 6211
SPECIAL ACCOUNT
2505 RITNER HIGHWAY
CARLISLE,PA 17015 DATE
ORD
Heat
D&LARS Ink
1:0 3 13 150 ]IC31: 10C3 L10420116 C3 2 1, 1
|
|
= ROWE'S AUCTION SERVICE (RH 79L)
2505 Ritner Highway • Carlisle,PA 17015
Bill Rowe (AU 1538L) 249-1978 215-1044 574-1008 Dave Rowe (AU 2295L)
Auction Is Action Call "Rowe" For Satisfaction p1
SELLERS NAME F- L L DATE �� 7
ADDRESS (. :� _y r-- L�-��. °� PHONE
OTHER �-.` L�� v�•�4 1 AUCTIONEER %
AUCTION DATE/LOCATION CLERK %
DESCRIPTION OF MERCHANDISE
/ S �c-
I Commission the Auctioneers to sell the merchandise to the highest bidder by Public Auction. Merchandise
to be s as is & grouped as n s ary to obtain bids. I certify that I am the owner or authorized represen-
tative of merchandis good d or property and have good title and the right to sell and that they are free
from ll ' mbrance a ept all responsibility for providing merchantable title and for delivery of
title t purchase I agre to d harmless the Auctioneers against any claims of the nature referred to in
this a ement.
f. AUCTION SIGNATURE SELLERS SIGNATURE
7&,e� �. .f o w `..'
Total Sales (Clerking Tickets Attached) $ L� tis e►r,t exccw'�0
Less Sale Expense:
3� %Commission Auctioneer $ L
%Commission Clerks $
OTHER:
TOTAL SALE EXPENSE DEDUCTED $
SELLERS NET $
+ i.aelA.F•"
Date : 01-06-2015 13:41W
Rowels Auction Service
j
' 2505 Ritner Highway
Carlisle, PA 17015
717-574-1008
lindenhall@aol. com
Settlement Tom Flower 243-5513 Page : 1
Seller: 16 Flower Law LLC
10 W. High St
Carlisle PA 17013
Item Description Price Qty Total
________________________________________________________________________________
- Karistan-style rug 1 160. 00
- Muffineer stand 1 4. 00
- Marble & glass ashtray 1 12. 00
- Nest of French stands 1 65. 00
- Maple rocker 1 10. 00
- Pole light/marble lights 1 20. 00
- End stands/ Rocker 1 12. 00
- Mahogany table 8 4 chairs 1 10. 00
- Pr. mahogany & leather top 1 22. 50
tables
Items : 9 Amount : 315. 50
Commission at 35. 000% 110. 42
Less adjustments : -110. 42
--------------
Net
__________Net due to seller : 205. 08
Thank you for your business !
,
REV-i5og EX+(oi-io)
pennsytvania SCHEDULE F
DEPARTMENT OF REVENUE
IJOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
CLYO E.KEENE 21-14-0726
If an asset became jointly owned within one year of the decedent's date of death,it must be reported on Schedule G.
SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A.LIDA COLLIER 157 CLIFTON PLACE NIECE
BEVERLY HILLS, FL 34465
B.
C.
JOINTLY OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY % DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENTS VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST
1. A. UNKNOWN CONTENTS OF CITIZENS BANK SAFE DEPOSIT BOX 236
665 N.EAST ST.,CARLISLE,PA 17013. EXECUTOR WAS NOT
PERMITTED TO ENTER AND INVENTORY CONTENTS OF BOX,
WHICH WAS TITLED JOINT WITH RIGHT OF SURVIVORSHIP.
TOTAL(Also enter on Line 6, Recapitulation) 0.00
If more space is needed,use additional sheets of paper of the same size,
REV-1511 EX+(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERUA14CE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CLYO E. KEENE 21-14-0726
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
EWING BROTHERS FUNERAL HOME,INC,PROFESSIONAL SERVICES 4,030.00
2. HEARSE,VEHICLES&EQUIPMENT 1,040.00
3. MURCHANDISE-DRESS,REGISTER BOOK,MEMORIAL FOLDERS 280.00
4. OBITUARY 355.65
5, DEATH CERTIFICATES 18.00
6. FLOWERS 159.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions: 5,000.00
Name(s)of Personal Representative(s) THOMAS E. FLOWER
Street Address-10 W. HIGH ST
City CARLISLE State PA Zip 17013
Year(s)Commission Paid: NOT YET 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: 373.50
5. Accountant Fees:
6. Tax Return Preparer Fees:
7. PUBLICATION OF ESTATE NOTICES 254.92
8. 2014-15 SCHOOL REAL ESTATE TAX 1,78625
9. THE TRAVELERS,HOMEOWNER'S FIRE AND HAZARD INSURANCE PREMIUM 836.00
10, S.MIDDLETON AUTHORITY,WATER/SEWER SERVICE 260.46
11. ADT,ALARM SYSTEM 154.79
12., CONTINUATION SHEET TOTAL 27,916.21
TOTAL(Also enter on Line 9,Recapitulation) $ 42,464.78
If more space is needed,use additional sheets of paper of the same size.
SCHEDULE H
continuation sheet
Estate of: File number:
CLYO E. KEENE 21-14-0726
1. Craig Anderson, mowing and general landscape maintenance 1,545.00
2. 2015 County/local real estate tax 460.09
3. Advantage Chemdry, pumping and initial mold remediation 3,215.65
4. Dehumidifier and hose 291.48
5. Thomas R. Fitzpatrick&Sons, replace sump pump, install
new heat pump and ductwork, remove damaged plumbing 13,452.72
6. Steve Harper, labor and dumpster rental 2,457.85
7. Steve Caramella,complete mold remediation, remove and
replace all subflooring, replace kitchen wainscoting, etc. 9,723.00
8. Vital records,two death certificates 18.00
9. PennDOT,duplicate vehicle title 50.00
10. PPL, electric service 687.42
11. SA Davis Electrical, replace electrical service panel and wiring 1,015.00
Subtotal: continuation sheet expenses. . . . . . . . . . . . . . . . . . . . . . . . . . . . 32,916.21
Less insurance paid for mold damage claim . . . . . . . . . . . . . . . . . . . . . . . . (5,000.00)
Total continuation sheet expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27,916.21
Ewing Brothers Funeral Home, Inc.
630 South Hanover Street
Carlisle,PA 17013
(717)243-2421
July 16, 2014
Lida(Keene)Collier
159 W. Clifton Place
Beverly Hills, FL 34465
The Funeral Service for Clyo E. Keene
We sincerely appreciate the confidence you have placed in us and will continue.to assist you in every way we can. Please
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES,FACILITIES,AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERALARRANGEMENTS.
Professional Services
Basic Services of PA L.F.D. 1,200.00
Bathing and Embalming 960.00
Other Preparation of Deceased 325.00
Basic Use of Facility 250.00
Documentation Prep/Recording 395.00
FD/Staff Supervision View/Visit/Service 375.00
Facility/Equip View/Visit/Service 375.00
FD/Staff for Interment Service 150.00
Total Professional Services -----------------a;i�31fi10----
Equipment
Transfer Deceased to Funeral Home 295.00
Hearse Usage 295.00
Safety/Lead Vehicle 150.00
Utility Vehicle 150.00
Family Vehicle 150.00
--------------------------------
Total Equipment 1,040.00
Merchandise
Dress 135.00
Register Book 40.00
Memorial Folders 95.00
Thank You Notes 10.00
Total Merchandise Selected ------------------- $I�i10----
AT THE TIME FUNERAL ARRANGEMENTS WERE MADE,WE ADVANCED CERTAIN PAYMENTS TO
OTHERS AS AN ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES.
Cash Advances
The Sentinel Obituary w.Photo 355.65
Death Certificates 18.00
Flowers 159.00
Total Cash Advances ------------------- 3 65----
SALES TAX 0.00
SUB-TOTAL 51882.65
INITIAL PAYMENT/DISCOUNT Aog DIT 100.00 WIDOW
TOTAL AMOUNT DUE 5,782.65 C'C
9eG�['iV 4�
REV-1512 EX+(12-08)
Uii' pennsylvania
,lSCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CLYO E. KEENE 21-14-0726
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. CRAIG ANDERSON,LAWN MOWING AND LANDSCAPING 665.00
2. BROCKIE PHARMATECH 12.72
3. THOMAS FILIP,DMD 132.00
4. CUMBERLAND EMS 86.13
5. PPL 23.76
TOTAL(Also enter on Line 10, Recapitulation) $ 919.61
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10)
pennsytvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
CLYO E. KEENE 21-14-0726
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. GREGORY LOVE,710 MEADOWVIEW DR,HARRIMAN,TN 37748 NEPHEW 771/2%
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.
NEW CENTURY METHODIST CHURCH,929 UNAKA ST,HARRIMAN,TN 37748 71/2 %
2 WEST STREET AME ZION CHURCH, 132-126 S.WEST ST,CARLISLE,PA 17013 15%
TOTAL OF PART A—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
CLYO E. KEENE
I, CLYO E. KEENE, of North Middleton Township, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do
hereby make, publish and declare this as and for my Last Will and Testament, hereby
revoking all other Wills and Codicils heretofore made by me.
FIRST +'
I direct the payment of my just debts and the expenses of my last illness and
funeral from.my estate as soon after my death as conveniently may be done.. 1. should
i
be,
buried at Cumberland Valley :Memorial 'Gardens, beside•--my: beloved •husband,
..Thomas C.. Keene.,,Jr,.;,who,.predeceased• me. My .funeral .should .be held :at .Ewing
.Brothers Funeral Home, with no viewing. I authorize my 'personal representative to
expend funds .from my .estate, in such amount as my personal representative shall
consider.nece.ssary and desirable to provide for the foregoing arrangements, as well as
for the purchase, erection and inscription of a suitable marker for my grave.
SECOND "
make the following specific bequests:
UDIS, 1 To my husband's niece, LIDA COLLIER, of Hernando, FL, I give my jewelry, my
)WER &
NDSAY
URNE,AMAW silverware, my throw pillows and my throws;
est High Street i{
;arlisle,PA
2. To my good friend, JOSEPHINE BROWN, of 830 Franklin Street, Carlisle, whose
husband was my husband's cousin, I give my stemware, my dishes and my quilts, as
well as any of my clothing that she wishes to take; .
�4
- s!
3. To my husband's godson, FORREST BROWN, of Carlisle, I give my living room
rugs, any of my furniture and bedding which he may want, and any automobile I may
own at the time of my death;
4. To my good friend, CONSTANCE HILL, of Carlisle, I give my large picture and
mirror hanging in my living room;
5. To Bernice North, of Steelton, my 27-inch television set and.my pocketbooks and
handbags.
THIRD
1 give, devise and bequeath the rest, residue. and remainder of my ,,estate; :as .:_-1
follows: .
Seventy (70%) percent to my . brother's..adopted: son, GREGORY -LOVE, .of
Harrirrian;`TN, in gratitude for the love a�nd''care,_ie gave to my:late`brother.;:ROBERT;'..> a:rt�:z�
-t Seven and one-half (7'/2 %) percent to my brother's adopted'so.n,.TER:R:Y-LOVE, i
of Harriman, TN;
Seven and one-half (7Y2 %) percent to the New Century Methodist Church of
Harriman, TN;
Fifteen (15%) percent to the West Street A.M.E. Zion Church, of Carlisle.
FOURTH
I direct that all inheritance taxes imposed upon the transfer of my estate passing
R� under this Will shall be paid out of the principal of my residuary estate, prior to its
LINDSAY
ATmRNEYSiT'`"" division into shares and without apportionment.
26 West High Street
Carlisle,PA
FIFTH
In addition to the powers conferred by law, I authorize any personal
representative acting under this instrument, in his absolute discretion:
2
A. To retain in the form received, or to sell either at public or private sale
any real or personal property;
B. To exercise any options to subscribe for stocks, bonds, or other
investments;
C. To join in any plan of lease, mortgage, consolidation, exchange,
reorganization or foreclosure of any corporation in which my estate or any trust
may hold stocks, bonds or other securities;
D. To sell, transfer, convey, mortgage, pledge, lease or exchange*any,
property, real or personal, which at any time may form part of my,estate;:for the`
payment of debts or taxes, or for any purpose of'administration O:r'distribution, for
.,.such.prices and upon such terms as my tporsonal* representative,' in his sole
discretion,, may deem wise, andl,.toexecute,and deliver.,.deeds'!;of;-conV �eyaric e-ory
transfer thereof,
E. To make settlements and compromises on such tial-Msas',ftly'persbna]
representative in his sole discretion may deem wisewithout the necessity:of
obtaining any court approval thereof;
F. To make distribution hereunder either in cash or kind, as my personal
representative in his discretion may deem wise.
SIXTH
SAIUDIS,
FLONAWR & I do hereby nominate, constitute and appoint James D. Flower, Jr., Esquire, to
LE14DSAY -
ATMINUS-AT-EAW act as Executor of this my Last Will and Testament.
26 West High Street
Carlisle,PA
SEVENTH
My personal representative shall not be required to give bond for the faithful
performance of his duties in any jurisdiction.
3
IN WITNESS WHEREOF, I, CLYO E. KEENE, have hereunto set my hand and
seal to this my Last Will and Testament, consisting of four (4) typewritten pages, the first
three (3) of which bear my signature in the margin for identification, this7' day of
October, 2006.
C,
CLY . KEENE � .
Signed, sealed, published and declared by-the.above=named,.UYO.E'.;, KEENE,,
..
Testatrix, as and for her Last Will and Testament in the presence.of us,-who; have
. hereunto subscribed our names.at her request as witnesses thereto;,in=the presence:of . . ,
said Testatrix and of each other. a
ADDRESS
ADDRESS 1V//l4 /71
C J
SAIDIS,
FLOWER &
LR1 DSAY
ATTORNEY'AT'Uw
26 West High Street
Carlisle,PA
4
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
We, CLYO E. KEENE, and '7 iA&17' the
Testatrix and witnesses, respectively whose names are signed to the foregoing or
attached instrument, being first duly sworn, do hereby declare to the undersigned
authority that the Testatrix signed and executed the instrument as her Last Will and
Testament and that she signed willingly and that executed as her free and voluntary act
for the purposes therein expressed, and that each of the witnesses, in the presence
and hearing of the Testatrix signed the Will as witnesses and that to the best of their
knowledge the Testatrix was at the time eighteen (18) or more years of age, of sound
mind and under no constraint or undue influence.
CLYO E. KEENE
�q/ 1w1C_1_
;, 7r►e;� s E: � « c�ZZ... ,Witness,
/ Witness
,Wiliness
;Subscribed, sworn to and. acknowledged.:before. me by CLYO E-.. KEENE,Ahe. .:. .
estatrix, and subscribed to and 'sworn or - -affirmed to before me . by
1 IF tt c eh and. z.> .� .�f' u_)a'A C ,
witnesses, this 13(s., day of Y;2006.
ZI-L"a' �)Q J'L
No blit
SAIDIS,
FLOWER & NO i�AL SEAL
LINDSAY MERLENE&MARHEYI01 NOTARY PUBLIC
'''°`��`"W CARLISLE, CUMBERl. j COUNTY, PA
26 Wcst High,srrce`
Carlisle,PA MY COMMISSION EXPIRES JUNE 8, 2010
5
CODICIL
OF
CLYO E. KEENE
1, CLYO E. KEENE, the within named Testatrix, do hereby make and publish this
Codicil of my Last Will and Testament dated October 13, 2006.
FIRST
I hereby amend ARTICLE SECOND of my said Will to provide as follows:
l.To my husband's niece, Lida Collier, of 159 Clifton Place, Beverly Hills, FL 34465,
I bequeath my rings,jewelry, silverware, throw pillows and throws;4. _ '...
2.To.Lida Collier's son, Nog n Harris give my-bedding; bed spreads; towels and
small hanging pictures, my red lamp and my living'ro6th Ynirror;
, _3. To Constance,Hill,.of Carlisle, I bequeath my' 1'arge living-',roam'hangirig picture;rriy,
stemware and„dishes in the kitchen,6upboard and"in`the china:closet;
4. To Gregory Love's daughter, Dyshall, I give rriy'packet books and any of'.'
clothing she may, be able to use;
5. To,my husband's godson, Forrest- Brown, of Carlisle, I give my living 'room
furniture, rugs and any household furnishings not otherwise bequeathed herein-,
6. To my brother's adopted son, Gregory Love of Harriman, TN, I give all of my
kitchen knives,pots and pans and other cooking utensils.
SECOND
I hereby amend ARTICLE THIRD of my said Will to provide as follows:
I give, devise and bequeath all the rest, residue and remainder of my estate, as follows:
i -
i •
1. To my brother's adopted son, Gregory Love, of Harriman, TN, in gratitude for the
love and care he gave to my late brother, Robert, Seventy-seven and one-half(77 ''/2%)
percent;
2. To the New Century Methodist Church of Harriman, TN, Seven and One-half(7
''/2%)percent;
3. To the West Street A.M.E. Zion Church of Carlisle, Fifteen (15%)percent.
THIRD
I hereby amend ARTICLE SIXTH of my said Will to provide as follows;. In.the even.
that James D.' Flower, Jr. is unable or unwilling to`act-..as.mY executor, then,fappoint'.
Thomas E. Flower as alternate executor.'
FOURTH
In all other respects I hereby ratify, confirm and republish niyt Last Will dated October'
13', 2006;together with this sole Codicil as and'for my`Last Will: q.
- -IN WITNESS WH-E-REOF,--I; CLYO E. KEENE, have-hereunfo`set•my'hand and seal
r
to this Codicil to my Last Will and Testament this day of : -2`� ;2010:
CLYO E. ENE
Signed, sealed,published and declared by CLYO E. KEENE the Testatrix, as and for a
Codicil to her Last Will and Testament in the presence of us, who have hereunto subscribed
our names at her request as witnesses, thereto, in the presence of said Testatrix and of each
other.
QA�_ t'Q-- ADDRESS a`ZG1 �-cJ
r
C
tL jl� ADDRESS A`9
174
COMMONWEALTH OF PENNSYLVANIA
ss.
COUNTY OF CUMBERLAND
We, CLYO E. KEENE, Tti-pM* E. RoWIZandk-AJA11- /U�the Testatrix
and witnesses, respectively whose names are signed to the foregoing or attached instrument,
being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed
and executed the instrument as her Codicil and that she signed willingly and that she executed
as her free and voluntary act for the purposes-therein expressed, and that.each of the
witnesses, in the presence and hearing of the Testatrix signed the Codicil as witness and that
to.the best of their knowledge the Testatrix was at the.Aime 1.8.or more-ty6ars of age, of sound
mind and under no constraint or undue influence.
CLYO E. ENE
Witin S
W"i t n,e
Subscribed, sworn to and acknowledged before me by CLYO E. KEENS,the Testatrix, and
�sqn'be 1 6, and-,
d to and swojm or affirmed to before Ine by 'Tt�OkA-,�
�/-PYX- 2-- LtW&- -1-
witnesses,this day of eb-t rtLl, I
h a cq(
.,---- otary Public
-NOTARIAL SEAT
BARBARA E.STEEL,Notary Public
Carlisle Born,Cumberland County,PA