HomeMy WebLinkAbout12-06-06
"'.1. EX +..., * REV-1500 OFFICIAL USE ONLY I
COM\lONVVEAL TH OF PENNSYlVANIA INHERITANCE TAX RETURN FILE NU ~BER
DEPARTMENT OF REVENUE RESIDENT DECEDENT 21 06 00464
DEPT. 280801
HARRISBURG. PA 17128-0801 COI NTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOC AL SECURITY NUMBER
GROVE, JR., ARTHUR W 31 11-01-1650
~
~ DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS ~ETURN MUST BE FILED IN DUPLICATE WITH THE
w 05/30/2006 11/23/1917
ld REGISTER OF WILLS
Q (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) SOC Al SECURITY NUMBER
jgI 1. Original Return 0 2. Supplemental Return o 3. R jemalnder Return (date of death prior to 12-13-82)
w
~ 0 4. Limited Estate 0 4a. Future Interest Compromise (date of death after o 5. F
~00(1Il ederal Estate Tax Return Required
uiii!~ 12-12~2)
wGo8 jgI 6. Decedent Died Testate (Attach copy 0 7. Decedent Maintained a Living Trust (Attach 0 8. 1 otal Number of Safe Deposit Boxes
:z:i....
UGoIII ofWdI) copy of Trust) -
Go
00( 0 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (date of death between o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
~-------~ ~-~--.,..........--..-,---"""".~.....,.........~~- - -....- ~ "-- - - -~------~- ---~~-~ -- -- - -- - --- - --- -~- -----,.....,.- - - -- --- ---- --~-
, I I
AME
o !E Hillary A. Dean, Esquire
~ l!l IRM NAME (If applieable)
8 ~ Martson Deardorff Williams & Otto
ElEPHONE NUMBER
717/243-3341
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
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W
Ill:
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
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)
COMPLETE MAILING ADDRESS
10 East High Street
Carlisle, P A 17013
(1) 100,000.00
(2) None
(3) None
(4) None
(5) 5,883.79
(6) None
(7) None
OFFICIAL USE ONLY
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(8)
(9)
(10)
9,896.80
16,204.01
(11)
26,100.81
79,782.98
(12)
13. Charitable and Governmental Bequests/Sec 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)
(13)
(14)
79,782.98
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15.Amount of Line 14 taxable at the spousal tax rate,
or transfers under Sec. 9116(a)(1.2)
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8
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16.Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
(15)
(16)
79,782.98
(17)
9,573.96
(18)
(19)
9,573.96
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Copyright 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
940 Walnut Bottom Road
CITY
STATE PA
Carlisle
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
9,000.00
473.68
Total Credits (A + B C)
3. InterestJPenalty if applicable
D. Interest
E. Penalty
TotallnterestJPenalty (D
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
- -----,-- -----
ZIP 17013
(1)
9,573.96
(2)
9,473.68
E) (3) 0.00
(4)
(5) 100.28
(SA)
(5B) 100.28
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE AP ROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;.................................................................................. ~ I
~: ::::~~h;e~~:i~~:~:~~e~=s~~~..~.~.~.I~.~~~.~~~.:.~~.~.~.~ .~~~~~~~~~~~..~.~.i~.~.~~~~~:::::::::::::::::::: .:::: ::::::::::::
d. receive the promise for life of either payments, benefits or care?............................................. ................
2. If death occurred after December 12, 1982, did decedent transfer property within one year of d ath without
receiving adequate consideration? ........... ....................... .......... ...... ....... .......... ....... ..................... ...... ........... ..... D ~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her d ath?......... D ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?..................................................................................................... ................ D ~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE GAD FILE IT AS PART OF THE RETURN.
2716 Linglestown Road
Harrisburg, P A 17110
ADDRESS
7428 Sterling Road
Harrisbur , PA 17112
ADDRESS
10 East Him Street
Carlisle, PA 17013
e and belief. it is true. correct and complete. Declaration of
DATE
/~/~ ()~
DATE
DATE
) \-~B-c&
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of ransfers to or for the use of the
surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the us of the surviving spouse is 0%
[72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the stat tory 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 twenty-one years of age or younger at eath to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [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% 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% [72 P.S. ~9 16 (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 blo d or adoption.
Decedent's Complete Address:
STREET ADDRESS
940 Walnut Bottom Road
CITY
Carlisle
STATE PA
ZIP 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
9,573.96
9,000.00
473.68
Total Credits (A + B C)
(2)
9,473.68
3. InterestlPenalty if applicable
D. Interest
E. Penalty
TotallnterestlPenalty (0
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
E) (3) 0.00
(4)
(5) 100.28
(SA)
(5B) 100.28
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE AP ROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;................................................................. ................ ~ I
b. retain the right to designate who shall use the property transferred or its income;................... ...........;....
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, did decedent transfer property within one year of de th without
receiving adequate consideration?..................................................................................................... ................ D ~
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her d ath?........ D ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?..................................................................................................... ................ D ~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE GAD FILE IT AS PART OF THE RETURN.
Uncler penalties of peljury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowled e and belief, it is true, correct and complete. Declaration of
rer other than tha rsonaI sentalive is based on all information of which preparer has an knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS
Gerald R. Grove
DATE
2716 Linglestown Road
Harrisburg, P A 17110
ADDRESS
7428 Sterlin..g Road
Harrisbur , PA 17112
ADDRESS
DATE
10 East Hilili Street
Carlisle, PA 17013
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of ransfers to or for the use of the
surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)).
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the us of the surviving spouse is 0%
[72 P.S. ~9116 (a) (1.1) (ii)). The statute does not exemot a transfer to a surviving spouse from tax, and the stat tory 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 twenty-one years of age or younger at eath to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [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%, 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% [72 P.S. ~9 16 (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 bloo or adoption.
..
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RET\JRN
RESIDENT DECEDENT
ESTATE OF GROVE, JR., ARTHUR W IF LE NUMBER
21 - 06 - 00464
All real proper'W owned solely or as a tenant In common must be reported at fair market value. I=air market value is defined as the price
at which property would be exchanged between a willing buyer and a wilnng seller, neither being comp~lIed to buy or sell, both having
reasonable knowledge of the relevant facts. Real property which Is jolntly-owned with right of su~ Ivorshlp must be disclosed on
schedule F.
ITEM
NUMBER
1
DESCRIPTION
VALUE AT DATE OF
DEATH
100,000.00
Residence at 301 Cavalry Road, Carlisle, North Middleton Township, Cumberland COlllnty, PA, known as
parcel no. 29-18-1367-050. Value is actual sale price (see settlement statement attachell)
TOTAL (Also enter on Line 1, Rec4 pitulatlon)
100,000.00
*
COMMONWEAlTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
GROVE, JR., ARTHUR W
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
-,
IF LE NUMBER
21 - 06 - 00464
Include the proceeds of litigation and the date the proceeds were received by the estate. All property ointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM
NUMBER
1
M&T Bank Checking Account No. 926043
DESCRIPTION
2
Harbold, real estate tax proration
3
UGI, refund of credit balance
4
U.S. Treasury, Civil Service Retirement benefit
TOTAL (Also enter on Line 5, Ree; pitulation)
VALUE AT DATE OF
DEATH
3,097.50
172.96
38.15
2,575.18
5,883.79
*
SCI-EDlI.E H
RN:RAL. EXPENSES &
~TlVECOSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
GROVE, JR., ARTHUR W
IF LE NUMBER
21 - 06 - 00464
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
B.
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
Hoffman-Roth Funeral Home, Carlisle, P A, balance
2
Gerald R. Grove, reimbursement for funeral reception costs
3
Carlisle Memorial Service, Inc., inscription on monument
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
2.
Street Address
City State _ Zip
Year(s) Commission paid
Attorney's Fees Martson Deardorff Williams & Otto (estimated)
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Zip
4.
Probate Fees
Register of Wills
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
1
Other Administrative Costs
Cumberland Law Journal, Advertising Letters Testamentary
2
The Sentinel, Advertising Letters Testamentary
Total of Continuation Schedule(s)
TOTAL (Also enter on line 9, Recapitulation:
105.52
293.00
170.00
5,950.00
302.00
75.00
144.29
2,856.99
9,896.80
.
* SchedUe H
FwsaI Expenses &
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN Mninistrative Costs cootinued
RESIDENT DECEDENT
ESTATE OF GROVE, JR., ARTHUR W IF LE NUMBER
21 - 06 - 00464
3 Certified Mail, Dept. of Public Welfare 4.64
4 Register of Wills, Short certificate 12.00
5 Expenses of sale of real estate (see settlement statement attached) 2,629.90
6 Register of Wills, Filing fee, Inheritance Tax Return 15.00
7 PPL, fmal bill 45.45
8 Reserved for additional probate fee, miscellaneous filing fees and expenses 150.00
Page 2 of Schedule H
- --
j-
.
'*' SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
COMMONWEALTH OF PENNSYLVANIA LIABILITIES, & LIENS
INHERITANCE TAX RETVRN
RESIDENT DECEDENT
ESTATE OF GROVE, JR., ARTHUR W IF LE NUMBER
21 - 06 - 00464
Include unreimbursed medical expenses.
ITEM DESCRIPTION AMOUNT
NUMBER
1 Manor Care, nursing home services 15,161.00
2 NeighborCare Pharmacy, balance not covered by insurance 775.43
3 PPL, electric service 47.58
4 West Shore EMS, medical bill, not covered by insurance 63.00
5 Healthdrive Dental Group, dental care not covered by insurance 157.00
TOTAL (Also enter on Line 10, Re( apitulatlon) 16,204.01
-- - -
. R
.
EV-1513 EX+ (9-00) W
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF GROVE, JR., ARTHUR W IF ILE NUMBER
21 - 06 - 00464
RELA TI ONSHIP TO AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DEe EDENT OF ESTATE
Ik> Not
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1 Gerald R. Grove and Pauline Grove Brother and Entire residue
2716 Linglestown Road, Harrisburg, P A 17110 Sister-in-I. w
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate. on Rev 1 500 cover sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS N )T
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 ( "OVER SHEET
-- - ---- - ----
~ ~ n
OMA NO 2502-0265 ~
A.
U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1.DFHA 2.nFmHA
6. FILE NUMBER:
1?1n?1 ,.....,.,,.,, n
8. MORTGAGE INS CASE NUMBER:
B. TYPE OF LOAN:
3. flCONV. WNINS. 4. OVA
7. LOAN NUMBER:
5.DcONv. INS.
SETTLEMENT STATEMENT
C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by th settlement agent are shown.
Items marked "(POC)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
10 3/98 (121C2.1.HARBOLD.PFD/12102.1.HARBOLD/6)
D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. I~AME AND ADDRESS OF LENDER:
Jere Harbold and
Mary Harbold
6 Robert Lane
Carlisle, PA 17013
Estate of Arthur W. Grove, Jr.
301 Cavalry Road
Carlisle, PA 17013
I. SETTLEMENT DATE:
G. PROPERTY LOCATION:
301 Cavalry Road
Carlisle, PA 17013
Cumberland County, PennSylvania
H. SETTLEMENT AGENT:
Martson Deardorff Williams & Otto
June 23, 2006
Adlustments For Items Unnaid Bv Seller AdiustmentsFoi Iterms Unosid Bv Seller
210. CountvlTwo. Taxes to 510. County/Two. Taxes to
211. School Taxes to 511. School Taxes to
212. Assessments to 512. Assessments to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PAID BY/FOR BORROWER 520. TOTAL REDUCTION AMO JNT DUE SELLER
300. CASH AT SETTLEMENT FROMITO BORROWE-R: 600. CASH AT SETTLEMENT TD/FROM SELLER:
301. Gross Amount Due From Borrower (line 12()) 100,211.46 601. Gross Amount Due'To Sell. r (line 420) .] I
302. Less Amount Paid Bv/For Borrower (Line 220) ( 602. Less Reductions ~I ie.$elle (Line 520) 1/ ,(
303. CASH ( X FROM)( TO)BORROWER , 100.211.46 603. CASH ( X TO)( Jt=tiOM SEU-ER r ~ ;
The undersigned her&'3~.\ wledge . ~ A a ~ple~ copy of pages 1 &2 of this statement & a~~ .ch";e~ s Jlff!/Jrd JJfh..er"fM"l. ~...." J
Borrower ~// /'/-#1!.rki// Seller l--'J.... ~ It ~~vv
e 7n~~ ViA -\;)[ /J lstateofArthlrW.~ove,af.
, I il 17..d {, J::ItI>. L II ./
. p -
PLACE OF SETTLEMENT
10 East High Street
Carlisle, PA 17013
~y OF B~W];R"S TRAI~CTION
11nn~ .AMQWlI.n..~ S:D~ .
101. Contract Sales Price 100,000.00
102. Personal Prooertv
103. SeWement Charaes to Borrower (Line 1400) 38.50
104.
105.
! P~irl Bv .~IIAr in
06/24/06 to 01/01/07
06/24/06 to 07/01/06
to
152.43
20.53
106. CountvlTwD. Taxes
107. School Taxes
108. Assessments
109.
110.
111.
112.
120. GROSS AMOUNT DUE FROM BORROWER
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER:
201. DepOsit or eamest money
202. Princiosl Amount of New Loan(s)
203. Existina loan(s) taken subiect to
204.
205.
206.
207.
208.
209.
100,211.46
MlUY Ha""'(J
St!-.H.
~";
K SUMMAR'IOF~U~R"S TRj NSAC;TION
400. ""D^CU~ nllF 'n ~~D'
401. Contract Sales Price
402. Personal Prooertv
403.
404.
405.
100,000.00 f)
406. CountvlTwo. Taxes
407. School Taxes
408. Assessments
409.
410.
411.
412.
420. GROSS AMOUNT DUE 7i:J SELLER
500. REDUCTIONS IN AMOUNT DUE TO SELLER:
501. Excess Deoosit (See Instr dions)
502. SeWement Charaes to Sel er (Line 1400)
503. Existina loan(s) taken sub Bct to
504. Payoff of first Mortgage
505. Payoff of second MortiJaliE
506.
507.
508.
509.
152.43 E
20.53 F:::
06/24/06 to 01/01/07
06/24/06 to 07/01/06
to
100,172.96
2,629.90
2,629.90
100,172.96
2,629.90
97,543.06
sell 'lE'~ 7-Je,~ ~
HUD-l\3-86) RESPA. HB4305.2
m M&fBank
499 Mitchell Street, illsboro, DE 19966
June 12, 2006
Martson, Deardorff, Williams & Otto
Attomeys & Counsellors At Law
10 East High Street
Carlisle, PA 17013
RE: Estate of Arthur W. Grove J .
Date of Death: May 30, 200
Social Security No.: 314-01-1650
Dear Ms. Myers:
In response to your request, please be advised that at the time of death, the above-
named decedent had on deposit with this bank the following ac ounts.
1. Account 1Ype........................... Checking Account
Account Number....................... 926043
Ownership (Names of}...............Arthur Grove Jr.
Opening Date. . ... .. .... .. ... ... ... .... .03/07/80 (account closed 06/07/06)
Balance on Date of Death........ .$3,097.50
Accrued Interest
$
0.00
Total...................................... .$3,097.50
The above named decedent did not have a safe deposit box.
For any additional information on the above accounts, cluding ownership,
statements and closures please contact our North Middleton branch at 717-240-4521.
Sincerely,
{'Aa'iI/lVJ Idtv:.rO
Charlene Warrington, Records Management
1-888-502-4349
SCH. "E J'~ I..J-e.n 1
Paae 2
L. SETTLEMENT CHARGES
700. TOTAL COMMISSION Based on Price !I: tal 01.. PAID FROM PAID FROM
Division of Commission7line 700) as Follows: BORROWER'S SELLER'S
701.$ to FUNDS AT FUNDS AT
702.$ to SETTLEMENT SETTLEMENT
703. Commission Paid at Settlement
704. to
800_ ITEMS DAVAal C IN WITH I nAN
801. Loan Origination Fee % to
802. Loan Discount % to
803. Appraisal Fee to
804. Credit Report to
805. Lender's Inspection Fee to
806. Mortgage Ins. Aco. Fee to
807. Assumption Fee to
808.
809,
810.
811.
1900. ITEMS AV cunCD TO RE PAlO IN
901. Interest From to @ $ Iday ( days %)
902. Mortoaoe Insurance Premium for months to
903. Hazard Insurance Premium for 1.0 years to
904.
905.
1000. I PU WITH I I:loInl:D
1001. Hazard Insurance ( $ per
1002. Mortoaoe Insurance (II $ oer
1003. CountvlTwo. Taxes ( $ oer
1004. School Taxes /11 $ per
1005. Assessments @ $ per
1006. lib $ per
1007. @ $ per
1008. tal $ per
1100. TITLE
1101. Settlement or Closino Fee to
1102. Abstract or Title Search to
1103. Title Examination to
1104. Tille Insurance Binder to
1105. Document Preparation to
1106. Notarv Fees to
1107. Attorney Certification to Martson Deardorff Williams & Olto 550.00
(includes above item numbers: )
1108. Title Insuranca to Lawvers Tille Insurance Comoanv
(includes above item numbers: )
1109. Lender's Coverage $
1110. Owner's Coverage $
1111. Endorsements 100/300/900 Lawyers Title Insurance Company
1112.
1113.
1200. ANU I
1201. Recording Fees: Deed $ 38.50; Mortgage $ ; Releases $ 38.50
1202. Citv/Countv Tax/Stamos: Deed 1,000.00' Mortgage 1,000.00
1203. State Tax/Stamas: Revenue Stamps 1,000.00; Mortgaae 1,000.00
1204.
1205.
11 ~M. AUUI I IUNAI ~ETTL IT
1301. Survey to
1302. Pest Insoection to
1303. Final Water/Sewer Bill to North Middlton Township Authoritv 14001290 79.90
1304.
1305.
1400. TOTAl SETTLEMENT CHARGES (Enter on Line. 103 Section J and 502, Section Kh - 38.50 2,629.90
By signing page 1 of 'his statement, the signatories acknowledge receipt of a compleled coptffi r ,ge statement.
Certified to be a true copy. Martson Deardorff William'! & ptto
Settlement Agent
St311. " fI II :I~eZS ( 12102.1.HARBOLD /12102.1.HARBOLO /6)
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HCR*ManorCare
MANORCARE CARLISLE 372
940 WALNUT BOTTOM ROAD
CARLISLE, PA 17013
(717)-249-0085
PRIVATE
STATEMENT
ROOM
GROVE, ARTHUR
1111,IIII!!!!!!!.!!!.!!!!!!:::::::::::::::: ::i:i::..i::;!r:::;:::!!!::::!!!j!:!!~R!~~(.~~!~:::~~!!;=:~~!:::!:!:!:::::::::::::::::::::::::::::: ::::::::!:::!:!:!:::::..... .... .:.....:......:;.............;...;.;.;
04/19-4/30/05 CO INSURANCE NOT COVERED BY INSURANCE
05/01-05/31/05 CO INSURANCE NOT COVERED BY INSURANCE
06/01-06/27/05 CO INSURANCE NOT COVERED BY INSURANCE
6/28-06/30/05 ROOM AND BOARD @ 5518.00/MONTH
06/28-06/30/05 NUTRITIONAL SUPPLEMENTS @ 7.00/DAY
07/01-07/31/05 ROOM AND BOARD @ 5518.00/MONTH
07/01-07/31/05 NUTRITIONAL SUPPLEMENTS @ 7.00/DAY
7/31/2005 WOUND TREATMENT
7n/2005 HAIRCUT
7/19/2005 HAIRCUT
8/1 0/2005 PAYMENT RECEIVED CHECK #2979
8/1/2005 DR CREEDEN (PODIATRIST)
8/9/2005 HAIRCUT
8/24/2005 WOUND TREATMENT
08/01-08/31/05 ROOM AND BOARD @ 5518.00/MONTH
9/28/2005 PAYMENT RECEIVED CHECK #3111
9/1/2005 WOUND TREATMENT
9n/2005 HAIRCUT
9/27/2005 DR CREEDEN (PODIATRIST)
9/29/2005 HAIRCUT
09/01-09/30/05 ROOM AND BOARD @ 5518.00/MONTH
1 0/24/2005 PAYMENT RECEIVED CHECK #3121
10/01-10/02/05 WOUND TREATMENT
10/11/2005 HAIRCUT
10/26/2005 HAIRCUT
10/01-10/31/05 ROOM AND BOARD @ 5518.00/MONTH
5CH.. ~ll ;I~ (
$ .00'/
$ .501/
$2 .00'/
$ .50.-/
v
$5,51 .00
Amount D e
(t )3
-$8.50 v
-$17,617.00 .,,/
-$5,990.00 ,/
$7,351.00
GROVE, ARTHUR 8528
11/1/2005 BALANCE FORWARD
11/8/2005 HAIRCUT
11/1-11/30/05 ROOM CHARGE @ 5518.00/MONTH
12/15/2005 PAYMENT RECEIVED CHECK #3134
12/15/2005 HAIRCUT
12/1-12/31/05 ROOM CHARGE @ 5518.00/MONTH
01/01-01/21/06 ROOM CHARGE @ 5!18.00/MONTH
2/23/2006 HAIRCUT
02/25-02/28/06 CO INSURANCE NOT COVERED BY INSURANCE
3/16/2006 PAYMENT RECEIVED CHECK #3152
03/01-03/31/06 CO INSURANCE NOT COVERED BY INSURANCE
4/4/2006 PAYMENT RECEIVED CHECK #3157
04/01-04/30/06 CO INSURANCE NOT COVERED BY INSURANCE
05/01-05/03/06 CO INSURANCE NOT COVERED BY INSURANCE
5/20/2006 CO INSURANCE NOT COVERED BY INSURANCE
5/10/2006 PAYMENT RECEIVED CHECK # 3166
05/04-05/08/06 ROOM CHARGE @ 5828.00/MONTH
OS/21-05/29/06 ROOM CHARGE @ 5828.00/MONTH
HCR*ManorCare
MANORCARE CARLISLE 372
940 WALNUT BOTTOM ROAD
CARLISLE, PA 17013
(717)-249-0085
I-I (2JS)
PRIVATE
STATEMENT
ROOM
$10.0 ;/
$5,518.0 i,,'
$3,738.0 v
$10.0 or
$476.0 /'
$3,689.0 ,,/
$3,570.0 ./
$357.0 "
$119.0 ~-
$940.00 ,,'
$1,692.00 ,/
Amount Due
i
J
-$5,738.00 v'
-$7,176.00 ,.,/
-$3,000.00 ~
-$1,923.0Q ,,/'
$15,161.00
~iDw&o
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August 25,2006
Ms. Kimberly L. Etzler
Business Office Manager
ManorCare Carlisle 372
940 Walnut Bottom Road
Carlisle, PAl 7013
RE: Arthur W. Grove Estate
Account No. 8528
Dear Kimberly:
Enclosed is estate check number 106 in the amountof$15,161.00 in aymentofthe account
balance in this account. Our understanding is that this satisfies the Esta e's obligation on this
account.
Very truly yours,
MARTSON DEARDORFF
LIAMS & OTTO
Corrine L. Myers (Mrs.)
Estates Administrator
Enclosures
F ',FILESIOA T AFILE\EST A TES\I 0600. Lm
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ESTATE OF ARTHUR W. GROVE. JR.
1 Q EAST HIGHT ST.
CARLISLE, PA 17013
!3O-2954J19
31J
106
DATI
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F \FILES\DA T AFILE\Eslate Planning\ 10600. \ . wiIl.2006
~(Q)(?lW
LAST WILL AND TESTAMENT
I, ARTHUR W. GROVE, JR., of North Middleton Towns ip, Cumberland County,
Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare
this to be my Last Will and Testament, hereby revoking any and all form r Wills or Codicils by me
made.
1.
I direct that all my legally enforceable debts, funeral expenses, t stamentary expenses and
all inheritance taxes (whether such taxes may be payable by my estate r by any recipient of any
property) shall be paid from my residuary estate as soon as practicable a er my decease and as part
of the administration of my estate. My Executor(s) shall have no du y or obligation to obtain
reimbursement for any such tax so paid, even though on proceeds of insu ce or other property not
passing under this Will.
2.
I give, devise and bequeath all of my estate, both real and personal property, to GERALD R.
GROVE and PAULINE GROVE, husband and wife, or the survivor ofthe , or, should both ofthem
predecease me, to their issue, per stirpes.
3.
I nominate, constitute and appoint my brother, GERALD R. ROVE, and my niece,
PAULETTE KONEVITCH, or the survivor of them, as Executor(s) of
4.
I direct that my Executor(s) shall not be required to file a bo d to secure the faithful
performance of their duties in any jurisdiction.
5.
I authorize and empower my Executor(s), in their sole and absolu e discretion, to purchase
or otherwise acquire and retain any investments of which I die seized or an real or personal property
of any nature; to sell, lease, pledge, mortgage, transfer, exchange, disp se of or grant options in
regard to any or all property of any kind forming a part of my estate for s ch terms and such prices
as they may deem advisable; to borrow money for any purposes connecte with the protection and
Page 1 of 3 Pages
\
1_-
($
[Initials]
. ..
preservation of my estate; to mortgage or pledge any real or personal pro erty forming a part of my
estate or to join in or secure the partition of same; to compromise any laims or demands of my
estate against others or of others against my estate; to make distributio in kind and to cause any
share to be composed of cash, property or undivided fractional shares in property different in kind
from any other share; to employ agents, attorneys and proxies and to del gate to them such power
as my Executor( s) consider( s) desirable and to pay reasonable compensati n for such services as may
be rendered by such agents, attorneys and proxies; and to execute and d liver such instruments as
may be necessary to carry out any of these powers. In addition, I direct hat my Executor(s) shall
have the power to conduct an inventory of any safe deposit box necess to the administration of
my estate.
IN WITNESS WHEREOF I have hereunto set my hand and s al this q1-h day of
\jQJIurry "JO/Y.p.
(SEAL)
SIGNED, SEALED, PUBLISHED AND DECLARED by the abo e-named Testator, as and
for his Last Will and Testament, in the presence of us, who at his request, ave hereunto subscribed
our names as witnesses thereto, in the presence of the said Testator and
'~.d.
Page 2 of 3 Pages
..
., .
COUNTY OF CUMBERLAND
I
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We, Arthur W. Grove, Jr., Hillary A. Dean, and J I (' -k ('/ g [1-. [' H <: I
the Testator and the witnesses, respectively, whose names are signed to \the foregoing instrument,
I
being first duly sworn, do hereby declare to the undersigned authority thrt the Testator signed and
executed the instrument as his last Will and that the Testator has sign~d willingly, and that the
Testator executed it as his free and voluntary act for the purposes thereiQ expressed, and that each
of the witnesses, in the presence and hearing of the Testator, signed the rill as a witness and that
to the best of his /her knowledge the Testator was at that time eighteen ye,s of age or older, of sound
mind and under no constraint or undue influence. I
)
: SS.
)
COMMONWEALTH OF PENNSYLVANIA
')J,
Arthur W. Grove, J ., T tator
j!~l{l/J~/
. Itness Ir I
(J/~i ~tttIi
Witness I
I
Subscribed, sworn to and acknowledged before me by Arthur W. Gtove, Jr., the Testator, and
subscribed and sworn to before me by Hillary A. Dean and V lC---hi.( { ~ \1'-. - CTt7:)
the witnesses, thiscfl--.day of ::1:.<< CUd;J ,cecC,.
I
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_ . (t /t......l).-L r r y L~ b- t-,-V
ry Public i (,)
NOTARI LSEAL
CORRINE L. MYER ,NOT AAY PUBLIC
CARLISLE BORO, COU TV OF CUMBERLAND
tl'( COMMISSION I IRES MAY 27, 2001
Page 3 of 3 Pages