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Home My WebLink About01-0536 /!! ",llll u"'" ....8 :ri..l U..II .. .. z o j::: xl!' j!~ :E o o /6" -<2.s -<( ~ /3 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT REVl500P:.(l.e7)~ COMMO~SYlVANIA OEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG PA 17128-0601 DECEDENTS NAME (lAST, FIRST. AND MIDDLE INITIAL) use a blank block III sepnte 1JIOrds l.J~:EOW.l' iUlfiJiiB8i 2 1 0 1 OOMTV """ o 5 3 6 ....... I- Z W C W CJ W C S T EVE N S A LIe E E SOCIAL SECURITY NUMBER DATE OF DEATH DATE OF BIRTH o 2 / 2 5/1 9 1 9 208-42-4611 05 /2 7/:2 0 0 1 (IF APPlICABlE) SURVIVING SPOUSE'S NAME (LAST, RRST, AND MIDDLE INrTW..) SOClAi. seCURITY NlJABER TIllS RETURN IIUST BE FILED IN DUPLICATE WTTH THE REGISTER OF WILLS !& l!l z 2 II .. .. .. c u N/A !XJ1.DriginaIRetum 02.Supplemen1oIRetum o 3. Remainder Retum 1,,","_"'. 12-''''') o 4. limited Es10te 0 4a. fu1llre Interes1Compromise l,,",of_""'12.12~~ 0 5. Federel EstateT"" Retum Required ~ 6. Decedent Died Tes10te 1_' "'" of") 0 7. Decedent Main10ined a Living Trust I_h "'" cfTMlJ ....Q B. To1o1 Number of Safe De~ Bo,es o 9. Litigation Proceeds Received 0 10. Spousal Poverty Credtt I"'" of_ _12.Ml"'.'~~ 0 11. Election 10 tax under Sec. 9113(A) -" Soh 0) THIS SECTION MUST BE COMPLETI!D. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NMlE COMPlETE MAILING ADDRESS GLORIA L. GRIFFIE FIRM NAME (If Applicable) 1. Real Es10te (Schedule A) 2. Stocks and Bonds (Schedule B) 3. CIose~ Held Corporetion,Partnership or Sole-Propnetorship z o ~ ::::l l- ii: 0( (.) W II:: 4. Mortga9es & Notes Receivable (Schedule OJ 5. Cash, Bank Deposi1s & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (\0101 Lines 1-7) .49,897.65 9. Funerel E'penses & Admin~llative Cosls (Schedule H) (9) (B) , 2 7 1 . 4 0 . 1 0 2 . 3 0 (11) (12) (13) 49'523'95 10. Debts of Deoeden\ Mortgage Liabilrnes, & Liens (Schedule I) (10) 11. Total Deductions (Iotal Lines 9 & 10) ,373.70 12. Net ValLIe of Estate (LineB minus Une 11) 13. Cha01able and Govemmen101 BequestslSec 9113 Trusts for which an eleclion to tax has not been made (Schedule J) 14_ Net Value Subject to Till (Line 12 minus Line 13) 15. Amount of line 14 taxable at the spousal tax rate ,.. X .n See instructions on reverse side for applicable percentage 16. Amount of line 14 taxable at 6% rete 4 9,5 2 3. 9 5 x4.~ 17. Amount of line 14laxable al15%rele x .15 (14) 49,523.95 (IS) 2 . 2.2 8. 5 8 (16) (17) (16) 2,228.58 16. Tax Due 19_ 81 Windy Hill Road DATE 8/16/01 ADDRESS DATE Decedent's Complete Address; STREET AOORESS Green Ridge Village Center 410 Big Spring Road , CITY Newville I STATE TZlPl7241 PA Tax Payments and Credits: 1. Tax Due (Page 1 Line 18) 2. CreditsJPayments A. Spousal Poverty Credit e, Prior Payments C. Discount .05263 (1) 2,228.58 11 7 . 29 Totai Credits (A. e. C) (2) 3. interesUPenalty ~ applicabie D, Interest E. Penalty T otai InteresVPenalty ( D . E ) (3) 0 4. if line 2 is greater than line 1 . line 3, enter the differenoe. This is the OVERPAYMENT. Check box on PlIO. 1 Lln.le to requests refund (4) 0 5, If iine 1 . line 3 is greater than line 2, enter the differenoe. This is the TAX DUE. (5) 2 , III .29 A. Enter the interest on the tax due. (5A) 0 8. Enter the total of Line 5. SA. This is the BALANCE DUE. (58) 2,111.29 /01,",,""__"" ".. "'" "",,,.dM~"~-'" Mak~.Check Payable to:.'~~~~S!€R..r~! ~/~LS~ 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; """"""""""'"'''''''''''''''''''''''''''''''''''''' 0 ~ b. retain the right to designate who shall use the property transferrad llr its income; ................ 0 /Qij c. retain a reversionary interest; or............................................................................................. 0 /Qij d. receive the promise for life of either payments, benefits or care? ......................................... 0 /Qij 2. If death occurred on or before December 12, 1982, did decedent within two years preceding death transfer property without receiving adequate consideration? If death occurred after December 12, 1982, did decadent transfer property within one year of death without receiving adequate consideration? ....................................,......................................................... 0 Kill 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ...................................................................................................................... 0 51 4. Did decedent own an individual retirement account, annuity, or other non-probate property?.... 0 51 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN ~.,",'''."._"_,,_,,l'Jk~'';.''._M_.._...~_..~_.-_---'_.. ..~~~,.y""" ,~"".~,,--.,"<"~"'~' ".,~ .~_...... ... 72 P.S. ~9116 (a) (1.1) (I) provided for the reduction olthe tax rate imposed on the net value oltransfers to or forthe use of the surviving spouse from 6% to 3% for dates of death on or after July 1, 1994 and before January " 1995. 72 P.S. ~9116 (a) (1.1) (ii) provided for the reduction of the rate imposed on the nel value oltransfers to or for the use of the surviving spouse from 3% to 0% for dates of death on or after January 1, 1995. The stalute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filin9 a lax return are still applicable even if the surviving spouse Is the only beneficiary. FOR DATES OF DEATH ON OR AFTER JANUARY 1, 1995 - Please answer the following queslion by ptacing an 'x' in the appropriate space. Did the decedent create a trust or similar arrangement which is solely for the surviving spouse's benefit for his or her entire lifetime? Yes 0 No UI If you answered yes to the above question, the tax on Ihe trust or similar arrangement is postponed until the death of the second spouse, at which time it will be fully taxable at the rate(s) applicable to the remainder beneficiary(ies). Enter the value of the trust on Schedule J. Part II, in order 10 remove it from the calculation of Ihe tax due in this estate. You may wish to file Schedule 0 in order to make the election available under Section 9113. If the election is '1)ade, the tnust or similar arrangement is taxed in the estate of Ihe first decedent spouse, the portion of the tnust or similar arrangeme\11 which benefits the surviving spouse is taxed at the zero tax rate, and the remainder is taxed at the rate(s) applicable to the remainder beneficiary(ies). If you choose to make the election. you must attach Schedule 0 to a timely-filed tax return, along with Schedule(s) K and/or M in order to show the apportionment of, the trust or similar arrangement between the surviving spouse and the remainder beneficiary(ies). t. ",- .~ REY.Moa EX+ (2-871 ~ SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY Please Print or r pe FILE NUMBER 21 - 01 - 0536 COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (All property jointly-owned with the Right of Surviv(trship must be disclosed on Schedule F) ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Allfirst Bank - Checking .Acct #00975-3830-2 $20,273.47 $12,162.67 $10,089.54 $7,003.65 $724.22 $17.80 2. Allfirst Bank - CD #8-700-810-1030719 3. Allfirst Bank - CD #8-700-814-0199451 4. Allfirst Bank - CD #80000001982441 5. Refund from Presbyterian Homes 6. Refund from GPU Energy Service SUBTOTAL $50,271.35 7. Payment for funeral Meal to Green Ridge Village -$148.40 8, Payment for Continuing Care RX -$102.30 9. Payment for Richard L. Webber, Esquire (Estate Consultatio ~) -$40.00 10. Payment to Register of Wills (file Will) -$83.00 SUBTOTAL -$373.70 TOTAL (Also enter on line 5, Recapitulation) s1>49,897.65 (Attach additional 8Y2" x 11" sheets if more space is needed.) Il allfirst : .' ALICE E STEVENS 81 WINDY HILL ROAD NEWVILLE PA 17241-9696 '...11 I, ,,'..1.1,1,,'.,,11 ,.,... 11.,',1.., 11.,'"'.,,.11 ,1'..1 P.~ , Statement Summary lJ.y f. 2O,n Ihrv June 5. ZOOt Alice E .t.v....s ~ allflrsl.""m t) 24-hour CUstomer 'ervl~ HlOO-533-463O Your money In the bank Account NaTM Account Number eal."ce on O6IOS Relationship With Interest Fixed Rate CD Fixed Rate CD 00975-3830.2 8.700.810.1030719 8.700.81~199451 $20,27S.Q7 12,162.67 10,089.sq $Q2,S2S.68 What )'Our Icons maan o Customer Service e Credit to your account o Important reminder I) Charge to )'Our account .. Other banks' ATM transaction For questions about your slalemeTlt or ch4nge Df IJIJdress information. please see page 2. ..J G11163 2 fY",\\ .al'n~'fO'H\&o;-r fI~'" eS/15/zeel 12:18 717532572& ALLFIRST SANK ---- ACCOUNT 11I5TORY INFORMATION Account 80000001982441 Ct12 001 Cll] 000 Ct14 000 et11 01 Prod ~e 103 FIXED RATE CD NamB ALICE E STEVENS AMOUNT / sve CHRGI RATE DATE DESCRIPTION TAX/RA 37.75 C 04/08101 01 INTEREST CREDIT 37.75 D 04/08/01 03 INT ~AYMENT 36.53 C 05/08/01 01 INTEREST CREDIT 36.53 D 05/08/01 03 IN'!' PAYMENT 37.75 C 06/08/01 01 INTEREST CREDIT 37.75 D 06/08/01 03 IN'!' PAYMENT ..17- 06/12/01 INTEREST ADJUSTMENT ~.65~ 06/08/01 CLOSING 3.65 06/13/01 INTtREST ADJUSTMENT 3.65 C 06/13/01 BALANCE YTD ADJ 3.65- 06/14/01 INTEREST ADJUSTMENT -PFI-Fwd PF2-Bkwd PF12-Help PA2-Prompt STPCI2S1 5'1'0047 I: LAST PAGE SEg aA'l'CH!'RAN 00436'000008800 , -PFI-Fwd ~2-Bkwd SEQ BATCH 'IRAN 00308 = 00348 00000 9801 00000 1'01 .J AMOUNT I VoTE PATE 7000.00 C 08/08/00 37.75 c 09/08/00 01 37.15 D 09/08/00 03 36.54 C 10/08/00 01 36.'4 D 10/08/00 03 '. 37.75 C J1/08/00 01 37.15 D J1/08/00 03 '36.;53 C 12/08/00 01 36;53 D 12/08/00 03 37.75 C 01108/01 01 37.15 D 01/08/01 03 37.16 C 02108/01 01 37.1' D 02/08/01 03 34.10 C 03/08/01 01 34.10 D 03/08/01 03 PF12-Ha1p PA2~Prompt. . five CHRG/ DESCRIPTION . ~AX/RA OP,EIfI~G I)!;POS IT IN:rEREST CREDIT I rrr P~ YJol;;NT INTEREST'. CREDIT JNT PAYMENT. .. INTEREST CREDIT IN'r I'AYMENT' IN'rEREST CREDIT INT PAYMENT :1N'rEREST CREDIT .7NT PAYMENT INTEREST CREDIT INT PAYMENT INTEREST CREDIT INT PAYMENT PAGE 113 "1l/.l~/U1 13:08:37 CURR LAST SWAIM HEALTH CENTER 210 BI~G ROAD .(717) n6-8256 ..---., !(+"{G< (Ie! ACCOUNTS RECEIVABLE STATEMENT Statement Date 5/30101 \ .'~M'_"~I""'_ ~ Pres6yterian J{omes, Inc. Balance Due: (724.22) ALICE STEVENS C/O GLORIA GRIFFIE 81 WINDY HILL RD. NEWVILLE, PA 17241 Account Number: 60966 Balance Forward 4911.48 Date Descriooon Charee PaYment/Credit Balance 5/17/01 Payment on ale 4/01 stntt 4911.48 0.00 5/21/01 Shampoo & Set 11.00 11.00 5/24/0 I Peri- Wash 4.03 15.03 5/24/01 Wipes Stay Dry 8.15 23.18 5/24/0 I Belted Undergarment 24.35 47.53 5/24/01 CreamIWash-1 Step 10z. 18.25 65.78 5/27/01-5/31/01 RoornlBoard-SelfPay (790.00) (724.22) PRESBYTERIAN HOMES 7/06/2001 No. 409689 1 ! I [ INVOICE DATE . .... REFID , .' DESCRIPTION TOTAL AMOUNT DISCOUNT AMOUNT APPLIED 6/28/2001 REF/STE REFUND ALICE STEVENS 724.22 0.00 724.22 - CHECK AMOUNT 724.22 TOTALS 724.22 0.00 724.22 ETURN one copy With your remlUance RETAIN one copy tor your records THIS IS THE ONLY COPY YOU WILL RECEIVE (i;pu SERVICE GPU SERVICE, INC. cJ( e;fu-r7c:L. 2321814 VOID D' JfO'I' CASHED W1THDf SlO D10YS " CRECK DATE e2-2o 311 AMOUNT I *********17.-B0 Check Ho. 2321814 107106120011 ~l>Y TO ALICE E STEVENS 'I'HI: (,RDER 81 WINDY HILL lID OF "NEWVILLE, PA 17241 EXACTLY *********17 DOLLAR8 80 CEt-lTS ~~-- C1t:1.ba.nlt Delaware, New CasUe, DE 1.9720 Yioe Px'es.id'Vlt and. ~ c;v.J hrviOl!'. %DC. U" i! ~ i! JrB Jr 10"" ':0 ~ Jr JrOO i!0 q.: ~B JrBOOqlo"" . VENDOR NO. !~OOOOOOOl DOC NO. 2000091841 PO NO INVOICE I RCPT . "DAT& DOCUMEN'r t VENDOR INV AMT DISCOlJl.."T NET AMO~T 004020009615 07/02/2001 1S0210412~ ~7.aO RefUnd on Ac.count , 100012227490 .RFr~-o ON ACCOUl~ ~HQUIRIEl:; V'.AY BE {>I~C::BJ) l~ lm".9 JEnsEY TO 1.::'StlO-fG2-.311S, !tEFUND m! ACCot1N'l' "INQUIRIES "JUly BE: DIRECTED_ I'N PA ""l'0 1-S00-!i.45-7741. --0.00 17.80 9~~~ENT SERVICES " ." COMPANY- ,..1""'......... .~- NUTRnnONMANAGEMENTSER~CESCOMPANY SPECIAL FUNCTION FORM fd titS!' . ~K.fi co 93 FACILITY: DATE: DEPARTMENT: G, I Oa.\(\ [H,\tf,~ DATE: TIME:. f 1(- f""\. NMlEOFIlEPRESENTATIVE: ,U -'1900 NUMBEROFGtlESTS: tjo - JU " LOCATION OF EVENT: K. D rL MENU CIJENT APPROVAL: NO ~ d- 0 LUfV(;f.-u. ~ -5 -- z t 5J-.~~-f Co)t:t=s 66 /fD- a'"' .30 - GU J YD ~ ? /0'lSv (YllJtF C~tt (illjlJt1J..e.. f() Gr2<dtJ (2J()GZ (I,Jfr17~ 2-10 Gt& ~P('''v, (J.O tv 1)JvtflG7 P If 17'L <f ( It rt-,.). ..J. J ;::)toE>.5 TYPE OF SERVICE: EXTRAS: I Per Person I Total I Candles Food Cost: I i ItlO'" I I I I Flowers Labor Cost: I . Programs Direct Cost: I I TI't-J. I <t4O 1 Favors Additional Cost: I Otber. TOTAL COSTS: / r[~L/lJ \ ... p<apeny of N..- M8n0gomenl _ Company . C260 9/98 OPS-117 NutriJious Food, Expert Management, Superior Service * * ~ TAT E MEN T * * Statement Date: 5/31/01 Page: 2: Account #: 100004915 Name: ALICE E. STeVENS GLORIA GRIFf'"IE 81 WINDY HI~L ROAD NEWVILLE, PA 17'241 If' you have any questi or,s r'egal'd i ng your t. i 'I 'I P 1 ease ca 11 (7171 567-2147 or 1-800-675-2279. Thank you! Date Descriptiorl City Amour,t -------- -------------------------------------------- --,..--....---- 5/15/01 RF# 752731 DOCUSATE SOD 100MG CAP 60 1.55 5/15/01 RF# 800066 COUMAOIN 3MG TABLET un :;:0 6.00 5/16/01 DOC#1587 PAYMENT - THANK YOU 130.90- 5/21/01 RF# 740379 NEUTRA-PHOS PWD PACKET 30 10.75 5/24/01 RX# 828698 AVELOX 400MG TAB 10 6.00 5/24/01 RX# 828870 OXYCONTIN 10MG TAB 60 6.00 5/24/01 RX", 828873 OXYCODONE 5MG CAP 30 6.0el Ending balance - Pay this amount ---------) 102.30 Past Due Current 31-60 days Past Due 61-90 days F'ast Due 90'" days -----.--.---- 102.30 .00 PAYMENT DUE 06/30/01 .00 .00 C,~'j1t15ty 6~//CJ . - - - - - - --- _. - - -- - - - - - - ----------- - - - - - --- - - - - -- -- - --- - - - - - -'. - -.. '. - -- -. -- - __f.. '-f':' 1- Please cut her'e and remit this por'tior, with payment 41'/0.2-30 Remit to: CONTINUING CARE RX 28 S 2ND ST IPO BOX 355 NEWPORT PA 17074 ,Staternli!nt dOlt,e: 5/:31/01 Ao::o::ount #: 100004'>'15 GRE End i rig bal ance: 102.30 Amount enclosed: /P/dZ- ~o Name: ALICE E. STEVENS GLORIA GRIFFIE 81 WINDY HILL ROAD NEWVILLE, PA 17241 * * S TAT E MEN T * * Statement Date: 5/31/01 Pag"': 1 IF you have any questions regarding your bill please call (717) 567-2147 or 1-800-675-2279. Thank you! Date 'Account #: 100004915 Name: ALICE E. STEVENS GLORIA GRIFFIE 81 WINDY HILL ROAD NEWVILLE, PA 17241 Description Qty -------- ---------------------------~-~-------------- ---------- Amount ...,.~ ,.,..,-~",--;~, 5/05/01 5/07/01 5/14/01 5/15/01 5/15/01 , 5/15/01 5/15/01 5/15/01 6/15/01 5/15/01 6/16/01 Previous Balance RF# 772764 FLOVENT INH 110MCG AEROSO RF# 740376 ALPHAGAN 0.2% EYE DROPS RX# 818220 SEREVENT INHALER 136 RF# 739237 LEVOTHYROXINE 0.1MG TAB RF# 739239PROZAC 20MG CAP RF# 739240 PRINIVIL 10MG TAB RF# 739251 FUROSEMIDE 80MG TAB RF# 739253 COLCHICINE 0.6MG TAB RF# 739254 ARICEPT 5MG TAB RF# 739297 ZYPREXA 2.5MG TAB RF# 739298 THEOPHYLLINE CR 200MG TAB ** continued on next page ** 13 13 30 30 30 30 30 30 30 90 5 130.90 6.00 6.00 6.00 6.00 6.00 6.00 6.00 6.00 6.00 6.00 6.00 Statement date: 5/31/01 CONTINUING CARE RX 28 S 2ND ST /PO BOX 355 NEWPORT PA 17074 Account #: 100004915 GRE Name: ALICE E. STEVENS GLORIA GRIFFIE 81 WINDY HILL ROAD NEWVILLE, PA 17241 Sent By: MICHAEL J. HANFT, ESQUIRE; 717 249 0457; Aug-15-01 11:36AM; Page 2/2 lAw Office of Michael J. Hanft 19 BrooIcwood Avmue, Suite 106 ClU"lisle. P A 17013 Ph:(7l7) 249-5373 Fax:(717) 249-0457 Estate of Alice E. Stevens 81 Windy Hill Road Newville, PA 17241 August 14,2001 Attelltion: clo Gloria 1. Griffie, Executrix File#: Inv #: 2368"()()1 3804 RE: ESTATE ADMlNISTRA nON DATE DESCRIPTION HOURS AMOUNT LAWYER Aug-I4-01 Meet with Gloria Griffie 40.00 RLW Totals 0.00 $40.00 Total Fees & Disbursements 540.00 Previous Balance Previous Payments $0.00 $0.00 C" Daluce Due Now $40.00 pi 4Q lb Ct<.. q '-t elltflol ~~-/4 RECEIPT FOR PAYMENT ------------------- ------------------- Cumberland County - Register Hanover and High Street Carlisle, PA 17013 Of wills Receipt Rece~pt Recelpt Date Time No. 6/06/2001 10:46:50 1025825 STEVENS ALICE E File Number 2001-00536 Remarks GLORIA L. GRIFFIE VZ ------------------------ Distribution of Receipt ------------------------ Transaction Description Payment Amount Payee Name PETITION FOR PROBA SHORT CERTIFICATE RENUNCIATION EXECU JCP FEE 70.00 3.00 5.00 5.00 CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN BUREAU OF RECEIPTS & CNTR M.D Check# 1015 Total Received...... ... $83.00 $83.00 AEV''''~''',". COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RES! NT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF ALICE E. STEVENS FILE NUMBER 21 - 01 - 0536 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Payment for funeral meal to Green Ridge Village $ 148.40 B. ADMINISTRATIVE COSTS: None 1. Personal Representative's Commissions Narne of Pe""nal Rep....ntative (s) Social Securtly Numbe~s) I EIN Number of Pe""nsl Rep....ntalive(s) Street Address City State Zip Yea~s) Commission Pa~: 2. Attorney Fees Richard L. Webber, Esquire $ 40.00 3. Fami~ Exemption: (If decedenfs address is not IlIe sarne as cIa;menfs, allach explanation) None Claimant S_ Address . City State Zip Relationship of Cia;men! to Decedent 4. Probate Fees Cumberland County Courthouse (to file Will) $ 83.00 . 5. Accounlanfs Fees None 6. Tax Retum Preparer's Fees None 7. TOTAL (Also enter 00 nne 9, Recapttulation) $ 271 .40 (ff more space is needed, insert additional sheets of the same size) RE';15I2EX.11.93'. COMMONWEA.lJH Of PEHN$YlIIANIA. INHERITANCE TAX IlETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS Please Print ar Type FILE NUMBER 21 - 01 - 0536 ESTATE OF ALICE E. STEVENS ITEM NUMBER DESCRIPTION . AMOUNT 1. Payment to Continuing Care RX Service $102.30 TOTAL (Also enter on line 10, Recapitulation) (If more space ;s needed, insert additional sheefs of some size.) $ 102.30 COMMONWEALTH Of PENNSYlVANIA . COUNTY Of CUMBERLAND 1 j 55: GLORIA T. GRIFFIE being duly sworn according to law, deposes and says that she , the Executrix of the Estete of Alice E. Stevens lale of 4l9_BJL~I',.inKJlp?d_,Newville, PA 17241 , Cumb.rl.nd County, P.., d.c...ed and that the within is an inventory made by Gloria L. Griffie ., the .aid of Ihe enlire estete 01 said decedent, consisting of all the personal property and reel e.tate, exc.pt real ..tete outside the Commonwealth of Penn.ylvania, and that the figure. oppo.it. eech it.m of the Inv.ntory represent it'. fair value a, of the dale of decedent'. death. 19 ftMX ~;L . Ex..{ufor . inidr.tor and .ubscribed be for. me, 81 Windy Hill Road Newville, PA 17241 Addr.SJ Date of Death 27th Day May Month 2001 V..r INSTRUCTIONS I. An inventory must be filed within three month, after appointm.nt of p.rsonal r'pr..entative. 2. A suppl.ment inventory mu,t be filed within thirty days of discovery of additional ....ts. 3. Additional sheets may b. attached a, to p.rsonalty or realty 4. See Article IV, Fiduciaries Act of 1949. .-< "'" N ..... .-< <( ~ . Q) .-< .-< 'M :> :> Q) z "0 -.; >- '" 0 .. ~ w - .... '" .. '" >- w ~ .. ('") D! ... u 0 III .. U") 0 w w C 0 :r '" en I I- .... ... -' ... Z .. .... Z -' <( 0 '" ... 0 ... I W 0 <( w ~ i- .... > Z '" f-< ..... N Z 0 en <"1 c C " .; III Z 0 0 '" U Z w <( '" .... ... ~ .., '" c U - .. H 0 -;: ....1, .. <(, oS> I .. E I - " .. -' U .. ... .. .... ~ .. c ~ o '*' <( ... .., ~ it .... o o ... Inventory of the real and personal estate of ALICE E. STEVENS deceased 1. Allfirst Bank - Checking Acct #00975-3830-2 $20,273 47 2. Allfirst Bank - CD #8-700-810-1030719 $12,162 67 3. Allfirst Bank - CD #8-700-814-0199451 $10,089 54 4. A1lfirst Bank - CD #80000001982441 $ 7,003 65 5. Refund from Presbyterian Homes $ 724 22 6. Refund from GPU Energy Service $ 17 80 SUBTOTAL $50,271 35 7. Payment for funeral meal to Green Ridge Village -$148 40 8. Payment for Continuing Care RX -$102 30 9. Payment to Richard L. Webber, Esquire (Estate Consultation) -$ 40 00 10. Payment to Register of Wills (filed Will) -$ 83 00 SUBTOTAL -$373 70 TOTAL $49,897 65 . IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE. Whether you will receive any money or property will be deter- mined wholly or partly by the decedent's will. If the decedent died without a will, whether you will receive any money or prop- erty will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, CARLISLE, PA In re Estate of ALICE E. STEVENS ,deceased. May 27, 2001 Estate No. 21-01-0536 (Name and Address) TO: Edward L. Stevens. Sr. 1175 Baltimore Road Shippensburg, PA 17257 Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below. GLORIA L. GRIFFIE 81 WINDY HILL ROAD NEWVILLE, PA 17241 The Decedent day of May Pennsylvania. ALICE E. STEVENS ,2001 ,at Cumberland ,died on the 27th County. Newville The Decedent died testate (with a Will); or The Decedent died intestate (without a Will). The personal representative of the Decedent is (name, address and telephone number). GLORIA L. GRIFFIE 81 WINDY HILL ROAD NEWVILLE, PA 17241 If the Decedent died testate, the will has been filed with the Office of the Register of Wills of Cumberland County, I Courthouse Square, Carlisle, Pa. 17013. Phone No. 717-240-6345 If the Decedent died intestate, a Petition for the Grant of Letters of Administration was filed with'the Office of the Register of Wills of Cumberland County, I Courthouse Square, Carlisle, Pa. 17013, Phone No. 717-240-6345. A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the char Date: 8/16>/01 Signature: Name (print) Gloria L. Griff Address 81 Windy Hill Road Newville, PA 17241 Telephone 1/17) 776-4900 Capacity: Personal Representative Counsel for personal representative W ILL I, ALICE E. STEVENS, of 10 Hollar Avenue, Shippensburg, Cumberland S:ounty, Pennsylvania, being of sound mind, memory and disposition, do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void all wills by me at any time heretofore made. FIRST. I order and direct the payment of all my just debts and funeral expenses as soon as may be convenient after my decease. SECOND. I give, devise and bequeath all my estate, real, personal and mixed, whatsoever and wheresoever situate, to my two childEen, EDWARD L. STEVENS and GLORIA L. GRIFFIE, share and share alike. THIRD. I nominate, constitute and appoint EDWARD L. STEVENS and GLORIA L. GRIFFIE, or the survivor of them, to be the Executors of this my Last Will and Testament. IN WITNESS WHEREOF, I, ALICE E. STEVENS, have hereunto set my hand and seal to this my Last Will and Testament, this "9a day of July, .1969. . t1L~ ek-~ (SEAL) . Signed, sealed, published and : declared by ALICE E. STEVENS, : the Testatrix, as and for her : Last Will and Testament, in the presence of us who have at her request signed our names as witnesses hereto in the presence of the said Testatrix and of each other. >na; c. xit~ ~a~~ ~vl~ . . . . . . . . : : : . . . . : : RE~-1513 EX+ \9-00*, COMMONWEALTH OF PENNSVLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF ,. FilE NUMBER 21-01-0536 RELATIONSHIP TO DECEDENT NAME AND ADDRESS OF PERSON(S} RECEIVING PROPERTY Do Not List Trustee(s) TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) \1.2}] GLORIA L. GRIFFIE DAUGHTER 81 Windy Hill Road Newville, PA 17241 AMOUNT OR SHARE OF ESTATE NUMBER I 50% 2. EDWARD L. STEVENS, SR. SON 1175 Baltimore Road Shippensburg, PA 17257 50% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET \I NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE ,. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-15DO COVER SHEET $ 49,897.65 (11 more space is needed, insert additional sheets of the same size)