HomeMy WebLinkAbout08-04-05
REV-1500 EX (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
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FILE NUMBER
21 - 05
COUNTY CODE YEAR
INHERITANCE TAX RETURN
RESIDENT DECEDENT
0008
NUMBER
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
GRUBB, Rum L.
DATE OF DEATH (MM.DD-YEAR) DATE OF BIRTH (MM.DD.YEAR)
12/22/2004 12/28/1915
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
SOCIAL SECURITY NUMBER
172-01-5255-
~ 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a, Future Interest Compromise (date of death after 12-12-82)
o 7, Decedent Maintained a Living Trust (Attach copy of Trust)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
o 3. Remainder Return (date of death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under See, 9113(A) (Attach Sch 0)
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NAME
COMPLETE MAILING ADDRESS
2520 Doehne Road
Harrisburg, PA 1 711 0
John A. Roe E
FIRM NAME (If Applicable)
TELEPHONE NUMBER
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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)
(1)
(2)
(3)
(4)
(5)
OFFICIAL USE ONLY
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93,223.11
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(6)
914.25
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6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter.Vivos Transfers & Miscellaneous Non.Probate Property
(Schedule G or L)
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(7)
(8)
224,982.10
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)
(9)
(10)
30,485.00
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(11) 30,485.00
(12) 194,497.10
(13) g
(14) 194,497 . ~ 0
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
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 ,0 _ (15)
x .0 AS.. (16)
R,752_37
194,497.10
16. Amount of Line 14 taxable at lineal rate
17, Amount of Line 14 taxable at sibling rate
x .12 (17)
18. Amount of Line 14 taxable at collateral rate
x ,15 (18)
19. Tax Due
(19)
8,752 37
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Decedent's Complete Address:
I STREET ADDRESS
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REV-1506 EX. (1-97)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Ruth L. Grubb
FILE NUMBER
21-2005-0008
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
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
Household Goods 685.00
Living Room $505.00
Kitchen 80.00
Bedroom 100.00
2 Medicare (refund for chairlift) 265.00
3 Aetna (retirement benefit for December) 253.00
4 Peoples Magazine (refund) 31.35
5 Guideposts (refund) 7.86
6 Capital Blue Cross (refund) 66.14
7 Capital Blue Cross (refund) 480.15
8 Central Penn Medical (refund) 29.20
9 Church of God Home (refund) 370.76
10 Church of God Home (entrance fee 40% refund) 31,000.00
11 Orrstown Bank
CD interest December 84.57
CD interest January 84.31
CD #4000000878 $15,000.00
Accrued Interest 11.10 15,011.10
CD #4000003791 $8,000.00
Accrued Interest 17.27 8,017.27
CD #5430070222 $8,000.00
Accrued Interest 22.79 8,022.79
12 M&T Bank
Checking Account #38969696 $10,641.89
Accrued Interest .74 10,642.63
CD Interest January 49.73
CD #031003913903918 18,077.23
Accrued Interest 30.79 18,108.02
13 M&T Bank (Estate account interest) 14.23
TOTAL (Also enteron line 5, Recapitulation) $ 93,223.11
(If more space is needed, insert additional sheets of the same size)
REV.1509 EX .(,.97)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Ruth L. Grubb
SCHEDULE F
JOINTLY-OWNED PROPERTY
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
A.
Suzanne G. Keller
B.
c.
JOiNTLY-OWNED PROPERTY:
ADDRESS
201 N. Belfield Avenue
Havertown, P A 19083
FILE NUMBER
21-2005-0008
RELATIONSHIP TO DECEDENT
daughter
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 5/1996 Orrstown Bank
Checking Account 410616 1828.50 50% 914.25
TOTAL,(Also enter on line 6, Recapitulation) $ 914.25
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(if more space IS needed, Insert additional sheets of the same size)
REV-1511EX' (1-97)
ESTATE OF
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
i/
COMMONWEALTH OF PBlNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21-2005-0008
Ruth L. Grubb
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
1.
2
3
4
B.
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
Hetrick Ftmeral Horne
Organist/soloist/Ministers
Flowers/Luncheon
Tombstone engraving/obituary
8,158.00
850.00
660.00
249.00
1.
ADMINiSTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) Suzanne G. Keller
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address 201 N. Belfield Ave.
Havertown
Zip
1 C}OR 1
11,202.00
PA
City
State
Year(s) Commission Paid:
2005
2.
3.
Attorney Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
7,480.00
City
Relationship of Claimant to Decedent
State
Zip
4.
Proba1e Fees
306.00
5.
Accountant's Fees
6.
Tax RetumPreparer's Fees
7.
West Shore EMS-BLS 134.00
8
Church of God Home (final rent check) 863.00
9
Suzanne G. Keller (gas/tolls Havertown to Carlisle acting as PO1\. 560.00
10
Estate checking account checks 22.75
TOTAL (Also enter on line 9, Recapitulation) $ 30,485. 00
(If more space IS needed, Insert additional sheets of the same size)
REV-1513 EX. (1-97)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Ruth L. Grubb
FILE NUMBER
21-2005-0008
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)
Suzanne G. Keller daughter V2 share
1. 201 N. Belfield A venue
Havertown, P A 19083
2 Edgar H. Grubb son lh share
41 Cornistas Court
Walnut Creek, CA 945<t8
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additionaL sheets of the same size)
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ORRSTOWN BANK
January 13, 2005
TO: John Alexander Roe
Attorney-At-Law
2520 Doehne Road
Harrisburg, PA 17110
FROM: Timothea Moose
Cust. Serv Op.
P.O. BOX 250
SHIPPENSBURG PA 17257-0250
RE: ESTATE OF Ruth L Grubb
DATE OF DEATH: December 22,2004
IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD, ON THE ABOVE DATE, THE
FOLLOWING ACCOUNTS WITH ORRSTOWN BANK:
CHECKING ACCOUNTS
ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPAL & ACCRUED INTEREST
410616 Ruth L Grubb 5/29/96 1,828.48 .02
Suzanne G Keller
SAVINGS ACCOUNTS
ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPAL & ACCRUED INTEREST
CERTIFICATES OF DEPOSIT
ACCOUNT NO. TITLE OF ACCOUNT
4000000878 Harold E Grubb
Ruth L Grubb
4000003791 Ruth L Grubb
5430070222 Harold E Grubb
Ruth L Grubb
DATE OPENED PRINCIPAL & ACCRUED INTEREST
1/13/03 15,000.00 11.10
4/28/04
7/30/02
8,000.00
8,000.00
17.27
22.79
P.O. BOX 250
SHIPPENSBURG, PA 17257
.
TEL. (717) 532-6114
Edward Jones
21 West High Street
Carlisle, PA 17013
(717) 258-4688
Art Amundsen
Investment Representative
EdwardJones
John Alexander Roe
2520 Doehne Rd.
Harrisburg, PA 17110-9622
January 25, 2005
RE: Estate of Ruth Grubb
Dear Mr. Roe,
Please find below the information requested regarding the accounts
RUTH L. GRUBB held with EDWARD JONES.
ACCOUNTS HELD: (1) Single Account # 377-08546-1-4
- Opened 03/15/04
(2) Joint Account with her late husband Harold E. Grubb
as the primary owner
- Opened 05/11/01
- Closed 04/20/04; All assets liquidated
ACCOUNT BALANCE AS OF DOD: $130,729.72 (Please see enclosed
worksheet for asset breakdown)
ACCRUED INTEREST: $41.00
Sirry::erely, .....
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A'rt Amundsen
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Historical Pricing Valuation Worksheet
Edward Jones Account Number: 377,-06040
12/,2.2- / Di
date
Date of death valuation
Alternate valuation
QUANTITY
SECURITY DESCRIPTION/CUSIP
VALUE PER ITEM
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This information is approved for use with the public.
EdwardJones
date
TOTAL VALUE
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Page 1 of 1
Revised: 19 Oct 2004
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m1 M&rBank
499 Mitchell Road, MiIIsboro, DE 19966 Mail Code DE-MB-12
Phone (888) 502-4349
Fax (302) 934-2955
January 24, 2005
John Alexander Roe
Attorney At Law
2520 Doehne Road
Harrisburg, Pennsylvania 17110-9622
Re: Estate of" Ruth 1. Grubb
Social Security: 172-01-5255
Date of Death: December 22, 2004
Dear Sir or Madam:
Per your inquiry dated January 11, 2005, please be advised that at the time of death, the above-named decedent had on
deposit with this bank the following:
1.
Type of Account
Checking Account
Account Number
38969696
Ownership (Names of)
Harold E Grubb, Ruth L Grubb, Joint Owners
Suzanne G Keller, POA
Opening Date
8/28/64
Balance on Date of Death
$10,641.89
Accrued Interest
$
0.74
Total
$10,642.63
2.
Type of Account
Certificate of Deposit
Account Number
031003913903915
Ownership (Names of)
Harold E Grubb, Ruth L Grubb, Joint Owners
Suzanne G Keller, POA
Opening Date
5/29/01
Balance on Date of Death
$18,077.23
$ 30.79
Accrued Interest
Total
$18,108.02
Please be advised, there was no safe deposit box found for the above decedent. For further account information,
regarding ownership, closures and/or reimbursement of funds, etc., please call the High Street Carlisle Office # 717-
240-4536.
Sincerely,
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Nancy Clagett
Records Management
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Register of Wills of CUMBERLAND County, Pennsylvania
INVENTORY
Estate of
Ruth L. Grubb
No. 21-2005-0008
also known as
Date of Death
12/22/2004
172-01-5255
, Deceased
Social Security No.
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all
of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that
the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and
that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum
at the end of this inventory. I/We verify that the statements made in this Inventory are true and correct. I/We underSTand that
false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to
authorities.
Name of
Attorney:
John A. Roe
07109
Personal Representative: h rd JJ ~ '
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I.D. No.:
Address:
2520 Doehne Rd.
Harrisburq, PA 17110
717/671-9870
Dated
'1/4/05
Talephone:
Description
Value
Household Goods
Living Room
Kitchen
Bedroom
Medicare (refund for chairlift
Aetna (retirement benefit for December)
Peoples Magazine (refund)
Guideposts (refund)
Capital Blue Cross (refund)
Capital Blue Cross (refund)
Central Penn Medical (refund)
Church of God Home (refund)
Church of God Home (entrance fee 40% refund)
Orrstown Bank
CD interest December
CD interest January
685.00
$505.00
80.00
100.00
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265 .00
~3.00
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Ss 7 86' C)
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f 66.14 i r~ h
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480.15: ':~')
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::0=29.20 -r]
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'.'970.76 i-n
31~00. 66 c:~
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84.57
84.31
Continued on Page Two... . . . . . .
Total:
(Attach Additional Sheets if necessary)
224,067.85
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may. at the election of the personal representative. include
the vallie of each item. but such figures should not be extended into the total of the Inventory_
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INVENTORY
Page Two
RUTH L. GRUBB
Orrstown Bank
CD #4000000878
Accrued Interest
CD #4000003791
Accrued Interest
CD #5430070222
Accrued Interest
$15,000.00
11.10
$8,000.00
17.27
$8,000.00
22.79
M&T Bank
Checking Account #38969696
Accrued Interest
CD Interest January
CD #031003913903918
Accrued Interest
M&T Bank (Estate Account Interest)
$10,641.89
.74
18,077.23
30.79
Edward Jones Account No. 377-08546
91 shs AT&T Corp @ 19.65
1803 shs Allied Irish banks PLC @ 40.27
10 shares Apple Computer @ 63.88
812 shs Bellsouth Corp. @ 28.18
99 shs Lucent Technologies, Inc. @ 3.78
100 shs PPL Corp. at 53.82
294 shs SBC Communications @ 25.95
284 shs Verizon Communication @ 41.17
Verizon stock refund
200 shs Weis Markets @ 38.68
NO.
SS#
2005-00008
172-01-5255
15,011.10
8,017.27
8,022.79
10,642.63
49.73
18,108.02
14.23
1,788.15
72,606.81
638.80
22,882.16
374.22
5,382.00
7,629.30
11,692.28
115.02
7,736.00