HomeMy WebLinkAbout08-04-06
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15056051047
REV-1500 EX (06-05)
PA Department of Revenue
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Number Date of Death
OFFICIAL USE ONLY
County Code Year
File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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Date of Birth
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Decedent's Last Name
Suffix
Decedent's First Name
MI
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(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
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Spouse's Social Security Number
:I 0 () :l. <; J 71 &'
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
c::::> 1. Original Return
c::::>
2. Supplemental Return
c::::>
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
c::::>
4. Limited Estate
c::::>
c::::>
c::::> 4a. Future Interest Compromise (date of
death after 12-12-82)
c::::> 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
c::::> 10. Spousal Poverty Credit (date of death c::::> 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
8. Total Number of Safe Deposit Boxes
c::::>
~j, I r J e t A( G t /;btJ 5
Firm Name (If Applicable)
First line of address
I b c t.l Yt/ 4' 11 H€t I / J<d
Second line of address
1/ 7
I
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/1J].2-
City or Post Office
State
ZIP Code
REGISTER OF WILLS USE ONLY I
RF.CORDED OFFICE OF
REGISTER OF \\lLLS
2006 AUG 04 PM 3:31
CLERh OF
ORPtL\~S' COl'RT
(T:.ffiERL\~D CO., P.\
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DATE FILED
Cel/I/5) e
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/70/5
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Correspondent's e-mail address:
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE ,OF P~~hN E~P~, NSI E F.OR, ~ILI.~ .P# ,. _ . DATE
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SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
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DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
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REv'-1.3(J'J EX Page 3
File Number
De-:edent's Complete Address:
~ DECEDENfSNAr;,iE-- -
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STREET ADDRESS
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CITY
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STATE
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ZIP
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Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2 Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1) 0
Total Credits ( A + B + C )
(21 0
3.
Interest/Penalty If applicable
D. Interest
E. Penaty
.
,,~
TotallnterestiPenalty ( D + E !
If Line 2 is greater than Line 1 + LlIle 3, enter the difference. This IS the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund.
(3)
o
(4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
(5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5B)
o
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
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:.. .......... ~
c-,
c. retain a reversionary interest: or.................... .... ............... . ................ ~~
d. receive the promise for life of either payments, benefits or care? .... . ...... .......... ~
2. If death occurred after December 12.1982, cid decedent transfer property within one year of death
without receiving adequate consideration" ... ............................. ............
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ........... L.J
4 Did decedent own an Individual Re:irement flccount annuity, or other non-probate property which
contains a beneficiary designation'! ............. ..... ... ... .... lXJ
No
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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 Of after July 1 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three (3) percent [72 P.S. S9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate illposed on the net value of transfers to or for the use of the surviving spouse's zero (0) percent
[72 P.S. S9116 (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 stili applicable even if the sCJrviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. s9116(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 four and one-half (4.5) percent, except as noted in
72 P.S. S9116(1.2) [72 P.S. s9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedents siblings is twelve (12) percent [72 P.S. s9116(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+ (6-98) \
.~~~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
l.clw }- J ( 4- S hl}\ ~ M
(j'p-,~ uS
FILE NUMBER
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value :s 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 which is jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
VALUE AT DATE
OF DEATH
DESCRIPTION
f~o Ur(cn
corr dIe P4.
('-,
I ("- Sid e...u ~
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\ 1013
w' \-h o..fyy.' Y
\ 1v5ocvt?s)
J2\3,06C
1.
)? '-t ,1 OVt1f C/-J' t' 511 c~J L,IJ [;:51'0. reS
(\ or-S- !.ia + 4 /J.)
tI D h'loh G~t i} 1)<'
(ll1So.0o<;q rt \)f"'J~vplt)feJI6~ ri)
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--~----- ---- ... ... .. ----;,,~~L (::e':-;~;:;, ~":~!"'at;o,,~l; - 2 ,3';':, ~r; - -- .
- ----.-- ---- ---.- ------- -------------.-------------.--------------------... --.---. -'--..----.------ -.-----__. ..J.:._______..L._____ _____________
(if rnort: 3pt'ce is ili,;t:dr;r1j T;S;jrt i-ldditional Sfleets uf l[:e :);-hl~t~ ~ize)
REV-1508 EX + (1-97)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
GrubbS, Cd wo.rd
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
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.
1
'3
Lt.
VALUE AT DATE
DESCRIPTION OF DEATH
"Of\Cj VOl' d riA ., to-~ e. xethp!:- yI Cfl~ ,"'lCtrKllf r~,Ad 12 tJoc .
);....,th 13V:v-flt'1 ~ orf-{()I. 0 , '. .) 3]0,3/5.
C 10<:-\ lJ t\-e 5 Car'" , 5falk'f',Oft-i'l"< $', bo,rl), C I) 5,1" (J.t...: 6-1 hnJS"
\) SA A J it v elt y)j Q 111- y)Lw1[Qh' ()
( J On9 oI-ln1~Y'1>> €..J ,'C-t- f.f
(v ~ dl' I (r) l..> tu ~ J ~V~'lJ{ }
lloD, /"310.
MeyY.'\ I L'j t\ lh (Jart ~ \.' D
L-r r2 A's )LClfh I if'\V~Y11btt-Po'f:t-rcl,'o))
'JI..:, 1 't /J8[j.
5
5 (fvere~h f5o..J'Ik
((}let-\{/ n 5 o-c t f.)
g'553~
$ 1, 21./~, 0 ~t/
TOTAL (Also enter on line 5, Recapitulation)
(If more space ,s needed, insert additional sheets of the same size)
F
REV-1510 EX + (1-97)
/()
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SCHEDULE G
INTER.VIVOS TRANSFERS &
MISC. NON.PROBA TE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Gru ~b{ 'f:d-tv.P d-
FILE NUMBER
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM
NUMBER
1.
DESCRIPTION OF PROPERTY
INCLUDE l hE NAME OF THE TRANSfEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER
ATTACH A COPY Of THE DEED FOR REAL ESTATE
DATE OF DEATH
VALUE OF ASSET
3 /1.-7 /0 ~
fU2) ]jlc
%OF
DECO'S
INTEREST
EXCLUSION TAXABLE VALUE
IF APPLICABLE)
y\r:r tl) \ t'1}') l ~ 1 K .It
100 I"
(61 33/P-
1
(V O-t) 9. vat d MO!1 ~ 1rfJ {t~Jet
({is 6n 5c~ edv/ e ~
Iv Vl d
lljDlJ ()
7 ~ [lOC)
Cr (iJf' ert y r r t1 n~{I2YfeJ +0 >fOJ je at( tvd 109
to 1f\J;\I)
TOTAL (Also enter on line 7, Recapitulation) $ to '2) ., 3 0>
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99)
c,,,& ,10
,p<)!jjj{ j.)\
'~~..;;;/';'/I~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
~JlY6-Yd (. ~rub0S
FILE NUMBER
Debts of decedent must be reported on Schedule 1.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
M€.>>1t1ho.l )€'W,LE' I Ct:'sket CjrC>l;lIehd~Jerv;(..-(>5
. t J
ohd"u &.ry) uf/eJ (;j- df6-tJ ' <:.eJt,J'L c.-fe
5219
B. ADMINISTRATIVE COSTS
Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City _____________________________ State __ Zip
Year(s) Commission 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
~
1b9
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ 5 38' 8
(If more space is needed, insert additional sheets of the same size)
04/28/2006
M831-047-3540-0430
GRUBBS, EDWARD F JR & SHIRLEY
160 UNION HALL RD
CARLISLE, PA 17013-8391
1'11111111111111111111111.111111111111111111111111111111I11111
1111111111111111111111111111111111111111111111111111111111111111111111111111I1111111111111
2006
354 MOUNTAIN SHADOW ESTATES #47
43 & 44
LOCATION:
RICHFIELD ST
( 21250.00 SQ FT)
ACRES:
0.4878
2005
2006
o
o
509
509
o
o
o
o
o
o
509
509
509 EL PASO COUNTY
o
509
.432259
2.20
2006-07 SCHOOL REAL ESTATE TAX NOTICE
CARLISLE AREA SCHOOL DISTRICT
JULY 1 2006
Bill No: 1397
PAYABLE
TO:
ROBIN K SOLLENBERGER
5 HILL DRIVE
CARLISLE. PA 17013
PHONE 717-249-0747
I Assessee Land Improvement Total
Values 30670 182240 212910
Discount 2.0000 Face Penaltv 10.000:
SCHOOL RIE 12.580 m 2624.84 2678.41 2946.25
TAX AMOUNT DUE ------> 2624.84 2678.41 2946.25
Due Date JULY -AUG SEPT-OCT AFTER 10/31
JESC:
MAP NO: 29-07-0471-006
LAND APPROX 2 ACRES
Residential Building
010866
"AX GRUBBS. EDWARD F JR
'AYER & SHIRLEY M GRUBBS
160 UNION HALL ROAD
CARLISLE PA 17013
If unpaid by 12/15/06 taxes will be turned over to Cumberland Co. Tax Claim Bureau. Return Bill with payment. For
a Receipt, return both copies with a Self Addressed Stamped Envelope. $1.00 fee for additional receipts requested.
OFFICE
HOURS:
MAR-APR-JUL-AUG TUE 10-4 THUR 10-6
MAY-JUN-SEPT-OCT THUR 10-6
APPT ONLY JAN-FEB-NOV-DEC
CALL FOR HRS LAST WEEK OF DISC
01397907012006000262484000267841000294625297
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USAA'
Quarterly Investment Statement
April 1 to June 30, 2006
DM3477 /085024
SHIRLEY M GRUBBS
1 60 UNION HALL RD
CARLISLE PA 17013-8391
Secure service, low prices
Get fast, secure service and lowest prices at usaa,com.
Access your investment accounts and statements, Go to
MarketWatch for S&P buy, sell and hold stock
recommendations; then choose a fund at the ETF Center
based on search criteria you select. Our lowest prices are
online.
Portfolio summary
.' . ... -... .....-....,......
t ()talpO"'1Qli(),,~I~e
$0,00
Portfolio value
March 31, 2006
Additions
Earnings
Change in market value
160,156,26
1,265.63
-1.285.43
Total portfolio value
June 30, 2006
$160,136.46
Gain/Ooss)
Unreali z ed gain/(lossl
$84.23
Gainl (Iossl on your current portfolio is only informational
and should not be used for tax reporting.
Portfolio allocation
';;.1'a
USAA Investment
Management Company
P,O. Box 659453
San Antonio. TX 78265
www.usaa.com
Customer service
USAA Touchline@
800-531-8448
800-531-8777
SHIRLEY M GRUBBS
Member number 006331362 Member since 1955
low-cost trades just $6.95
Trade online for as low as $6.95 - it's one of the nation's
lowest commissions ever. And now we offer an easier way
to get there. Limitations apply. Visit usaa.com for information
and a commission schedule, and place a trade order today.
Portfolio performance
'''']J
$135,00 u
''',00 ','
$4b.00 u n
$
2006
Annualized total return
N/A
The total return is the annualized percentage change in the value
of your portfoliO.
Value on % of
June 30, 2006 portfolio
Tax Exempt Bonds
$ 160. 136. 46 100, 00
$160,136.46 100.00%
Total portfolio value
i
~
I
i
Tax Exempt Bonds
Please review this statement carefully and notify us within '10 days of any
errors or omissions For details on the information in this statement, see
"About Your Account",
, [)ov8relgn Bank"
/\ r f: lvll~:. r F:
1-877-SQV-BANK (1-877-768-2265) www.sovereignbank.com
statement Period 06/08/06 TO 07/09/06
THE SOVEREICN ONE ACCOUNT
THE SOVEREleN ONE ACCOUNT statement Period 06/08/06 - 07/09/06
EDWARD F GRUBBS
SHIRLEY M GRUBBS
Account # 2891027523
Former Account H 90247032
Balances
Beginning Balance
Deposits/Credits
Withdrawals/Debits
Interest
Paid this Period *
Earned this Period
Paid Year-To-Date
$ 19.53
$ 19.53
$ 324.38
Annual Percentage Yield Earned
Paid Last Year
2.00%
$12,090.43
+ $5,355.46
- $7,300.56
Current Balance
Average Daily Balance
$10,145.33
$11,253.59
$928.78
*The interest earned and the interest paid may differ depending on when interest is credited to your account.
Checks Posted
Check # Date Paid Amount Reference # Check # Date Paid Amount Reference #
3008 06/16 · $824.00 613780970 3012 06/27 $132.50 612951390
3009 06/19 $5,000.00 641939820 3013 06/28 $250.00 614015830
3010 06/27 $40.05 642024060 3015* 07/06 $63.59 641503880
3011 06/27 $685.00 627053670 3016 07/05 $150.00 695504640
8 Check(s) Posted = $7,145.14
An asterisk (*) indicates a skip in sequential check numbers which may be caused by one of the following:
. A check not yet received
. A check that was converted to an electronic transaction, which will be listed in the "Electronic Checks Posted"
section below. If no checks were electronically converted, this section will not appear.
Account Activity
Date Description
06-08 Beginning Balance
06-09 T -MOBILE PCS SVC
060608
PP ELEC BILL
1495068008WS
DEPOSIT
CHECK
CHECK
Additions
Subtractions
Balance
-$25.15
$12,090.43
$12,065.28
--~--$54~29-----$1-2,01 0.99
06-1 2
06-14
06-16
06-19
..$3,795.34
3008
3009
,- $824.00
. $5,000.00
$15,806.33
$14,982.33
$9,982.33
page 3 0/5
2891027523
June 30, 2006, year-to-date
Page 1 of 1
TRANSACTION DETAIL
THNanguard:JRoUP,
SHIRLEY M GRUBBS
160 UNION HALL RD
CARLISLE PA 17013
(800) 662-2739 Client Services
www.vanguard.com Website
(800) 662-6273 - Tde-Account
~
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<D
TRANSACTION ACTIVITY
Vanguard Pennsylvania Tax-Exempt Money Market Fund Fund / Account no. 0063 / 88013417424
"!,"~(j~(:Ja!e___"!'"il0~<:;tion descrip.t~c>!:l__ .____ __ __ __,______ ___~oJl.ar,a':flo~~__~har~erice_~_S'2~~s..!r a.!ls..ac;t~d___:!"C>!.a.1 ~hare~'i...<J~~<:l
Balance on 12/31/2005 $0.00 $1.00 .000
4/27 Transfer from 9896587974 71,707.02 1.00 71,707.020 71,707.020
4/27 Dividend from 9896587974 171.03 1.00 171.030 71,878.050
4/28 Income dividend 21.25 1.00 21.250 71,899.300
5/31 Income dividend 205.41 1.00 205.410 72,104.710
6/30 Income dividend 208.38 1.00 208.380 72,313.090
Balance on 6/30/2006 $ 72,313.09 $1.00 72,313.090
Year -to-date
TaJ<:~)(ernP~ inc;c>~_~.,
$ 435.04
Purchases / Annualized
,_ __Fi!'E~mf?tions__,_____ _~_~_________ '0_ yield
$ 71,878.05
0.00
3.51%
Compound Distribution
~ml1lJ~ Ylelcj__e?Y~l:l.le dat~
3.56% 7/03/2006
VANGUARD PENNSYLVANIA TAX-EXEMPT
MONEY MARKET FUND
*00 not alter this Invest-By-Mail slip.
'Visit www.vanguard.com or call to change your address.
Fund / Account no.
0063 / 8801 341 7424
SHIRLEY M GRUBBS
Make checks payable to: The Vanguard Group - 0063
List each check $
'iepar ately. $
$
$
Total amount $
THE VANGUARD GROUP
PO BOX 13750
PHILADELPHIA PA 19101-9897
I...III.IIIIJ.IIII......III.I..I..I.I.I..I...I,I,I,I
00635
88013417424
307
Old 1 ::'8/7 I
080163
;;
1 1
lID 10,m Mt '.1 X
111111111111111111111111111111111111111111111111111111111111111111111111111
Hoffman-Roth Funeral Home, Inc.
219 North Hanover Street
Carlisle, P A 17013
(717)243-4511
April 14, 2006
Shirley Grubbs
160 Union Hall Rd.
Carlisle, P A 17013-
The Funeral Service for Edward "Joe" F. Grubbs
14734-63
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 FUNERAL ARRANGEMENTS.
FACILITY, STAFF, EQUIPMENT
Memorial Service (Conducted at another facility) . .
FUNERAL HOME SERVICE CHARGES
SELECTED MERCHANDISE:
Kinsey Casket. . . . . . . . . . . . . . . . . . . . . . .
Cave Proof, Concrete Box Int Recepc . . . . . . . . . . . . . . . .
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
THAT YOU HAVE SELECTED . . . . . . . . . . . . .
Cash Advances
Opening Grave. . . . . . . .
Newspaper Obituary Notice-Sentinel .
Certified Copies of Death Certificate .
TOTAL CASH ADVANCES AND SPECIAL CHARGES .
Total
Total Cost .
~.
To be credited when receive from Cumberland County VA
This statement is net and payable in full within 30 days of receipt.
$3025.00
$3025.00
$760.00
$860.00
$4645.00
$450.00
$205.85
$18.00
$673.85
$5318.85
$5318.85
100.00
Please return this portion with your Remittance
TOTAL AMOUNTY DUE ..........................'10 C~?lQ.8~
- - - - - - - - - - . - . - - - . - . . - - - - - - - - - - - - - --- - - - . - - - - - - . - - - - ~~." - ~. - - - - - - -
$
Service 10 # 14734-63
Amount Enclosed
Edward "Joe" F. Grubbs
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